Bi-Specific Fusion Proteins

ABSTRACT

Bi-specific fusion proteins with therapeutic uses are provided, as well as pharmaceutical compositions comprising such fusion proteins, and methods for using such fusion proteins to repair or regenerate damaged or diseased tissue. The bi-specific fusion proteins generally comprise: (a) a targeting polypeptide domain that binds to a target molecule; and (b) an activator domain that detectably modulates tissue regeneration.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.15/618,478, filed Jun. 9, 2017, which is a continuation of U.S.application Ser. No. 14/967,980, filed Dec. 14, 2015, now U.S. Pat. No.9,718,892, which is a division of U.S. application Ser. No. 13/068,808,filed May 20, 2011, now U.S. Pat. No. 9,238,080, which claims thebenefit of and priority to U.S. Provisional Application Ser. No.61/347,040, filed May 21, 2010, the entire content of each of which isherein incorporated by reference in their entirety. Reference is alsomade to U.S. application Ser. No. 13/112,907, filed May 20, 2011, nowU.S. Pat. No. 8,691,771, which is incorporated herein by reference.

REFERENCE TO SEQUENCE LISTING

This specification includes a sequence listing provided on a compactdisc, submitted herewith, which includes the file entitled 132463-010104ST25.txt having the following size: 961,000 bytes which was created May20, 2011, the contents of which are incorporated by reference herein.

TECHNICAL FIELD

The present invention relates generally to fusion proteins that havetherapeutic uses, and more specifically to bi-specific fusion proteins,pharmaceutical compositions comprising such fusion proteins, and methodsfor using such fusion proteins to repair damaged tissue.

BACKGROUND

Tissue regeneration is a multidisciplinary science in which the goal isto restore biological function of diseased or damaged tissues. Tissueregeneration addresses major clinical problems such as myocardialinfarction. Myocardial infarction, commonly known as a heart attack,occurs when coronary artery obstruction cuts off the blood supply topart of the heart. The resulting lack of oxygen causes irreversibletissue damage (necrosis and apoptosis), due to the inability of theheart to sufficiently activate endogenous regeneration programs andself-repair. Such tissue damage is a leading cause of congestive heartfailure, a condition in which the heart is no longer capable ofeffectively pumping blood. In the United States, there are more than amillion heart attacks every year, and nearly 5 million people areafflicted with congestive heart failure.

There are no effective treatments for regenerating damaged cardiactissue. Current therapies for congestive heart failure focus onpreventing arrhythmia, progression of arteriosclerosis and recurrentmyocardial infarction, but do not address the underlying tissue damage.More than half of patients diagnosed with congestive heart failure diewithin five years of diagnosis.

Stem cell therapy is a potential new strategy for cardiac repair. In thelaboratory, it is possible to generate cardiac muscle cells from stemcells. This suggests that stems cells could be used to repair damagedtissue such as cardiac tissue in a patient; however, no therapeutictreatments based on such an approach are presently available. Onedifficulty that has been encountered in stem cell therapy is that oftargeting sufficient numbers of stem cells to the damaged tissue toresult in clinically significant repair.

There is, thus, a need in the art for methods for repairing orregenerating damaged tissues, and for improving the targeting of cellssuch as stem cells to facilitate tissue repair. The present inventionfulfills these needs, and provides other related advantages.

SUMMARY OF THE INVENTION

The present invention provides bi-specific fusion proteins, nucleic acidmolecules encoding bi-specific fusion proteins and therapeutic methodsthat employ such bi-specific fusion proteins. In certain aspects, thepresent invention provides bi-specific fusion proteins that comprise:(a) a targeting domain having a binding specificity to a target moleculeassociated with a damaged cell of a tissue, wherein the molecule isintracellular in a viable cell and exposed to the extracellular space inthe damaged cell; and (b) an activator domain having a bindingspecificity to a growth factor receptor associated with a surface of acell in the tissue, wherein upon exposure of the activator domain to thegrowth factor receptor, the activator domain binds the growth factorreceptor so as to modulate regeneration or survival of the tissue. Insome embodiments, the bi-specific protein further comprises a peptidehalf life modulator.

In certain aspects of the invention, the bi-specific fusion proteincomprises (a) a targeting domain having a binding specificity to atarget molecule associated with a damaged cell of a tissue, wherein themolecule is intracellular in a viable cell and exposed to theextracellular space in the damaged cell; (b) an activator domain havinga binding specificity to a molecule associated with the surface of acell in the tissue, wherein upon exposure of the activator domain tosurface-associated molecule, the activator domain binds thesurface-associated molecule so as to modulate regeneration or survivalof the tissue; and (c) a half life modulator wherein the half lifemodulator modulates the half life of the bi-specific fusion protein.

In other aspects of the invention, the bi-specific fusion proteincomprises (a) a targeting domain having a binding specificity to atarget molecule associated with a tissue; (b) an activator domain havinga binding specificity to a molecule associated with the surface of acell in the tissue, wherein upon exposure of the activator domain to themolecule, the activator domain binds the molecule so as to modulateregeneration or survival of the tissue; and (c) a half life modulatorwherein the half life modulator modulates the half life of thebi-specific fusion protein.

In other aspects of the invention, the bi-specific fusion proteincomprises (a) a targeting domain having a binding specificity to atarget molecule associated with a tissue; (b) a binding domain having abinding specificity to a molecule associated with the surface of a cellin the tissue, wherein upon exposure of the binding domain to themolecule, the binding domain binds the molecule so as to promoteregeneration or survival of the tissue; and (c) a half life modulatorwherein the half life modulator modulates the half life of thebi-specific fusion protein.

Yet other aspects of the invention relate to a fusion protein comprising(a) at least one targeting domain having a binding specificity to atleast one target molecule associated with a tissue; (b) at least oneactivator domain having a binding specificity to at least one moleculeassociated with the surface of a cell in the tissue, wherein uponexposure of the activator domain to the molecule, the activator domainbinds the molecule so as to promote regeneration or survival of thetissue; and (c) a half life modulator wherein the half life modulatormodulates the half life of the fusion protein.

In some embodiments, the activator domain or the binding domain bindsspecifically to a growth factor receptor, cytokine receptor or stemcell-associated antigen. In some embodiments, the targeting domain doesnot have a biological activity. The targeting domain and the activatordomain can bind different molecules on a same cell or can bind differentmolecules on different cells.

In some embodiments, the activator domain is selected from the groupconsisting of: fibroblast growth factor (FGF), epidermal-growth factor(EGF), neuregulin/heregulin (NRG/HRG), insulin-like growth factor (IGF),hepatocyte growth factor (HGF), thymosin, granulocyte colony stimulatingfactor (G-CSF), stem cell factor (SCF)/mast cell growth factor (MGF),periostin, vascular endothelial growth factor (VEGF), stromalcell-derived factor (SDF), platelet-derived growth factor (PDGF),tetracarcinoma-derived growth factor (TDGF), beta-nerve growth factor(NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3),thrombopoietin (TPO), bone morphogenic protein (BMP), activin A,betacellulin, beta-catenin, dickkopf homolog 1 (DKK1), erythropoietin(EPO), growth hormone (GH), heparin-binding EGF-like growth factor(HBEGF), insulin, interleukin (IL) leukemia inhibitory factor (LIF),monocyte chemotactic protein 1 (MCP1/CCL2), pleiotrophin (PTN),transforming growth factor (TGF), tumor necrosis factor (TNF), Wnt, anantibody having a specificity for an activator receptor, variantsthereof, isoforms thereof, fragments thereof, and combinations thereof.In some embodiments, the activator domain comprises a sequence recitedin any one of SEQ ID NOs: 3-9, 32-40, or 50-64.

The targeting domain can be at the amino terminus and the activatordomain at the carboxy terminus of the fusion protein. In someembodiments, the targeting domain is at the carboxy terminus and theactivator domain is at the amino terminus of the fusion protein. In someembodiments, the targeting domain is at the carboxy terminus and theactivator domain is at the amino terminus of the fusion protein.

In some embodiments, the half life modulator is a non-immunogenicprotein. The half life modulator can comprise a sequence from one ofhuman serum albumin, domain III of human serum albumin,alpha-fetoprotein, vitamin D-binding protein, transthyretin antibody Fcdomain, single-chain version of antibody Fc domain, proline-, alanine-,and/or serine-rich sequences, variants thereof, fragments thereof, andcombinations thereof. For example, the half life modulator comprises atleast 100 consecutive amino acids that are at least 80% identical to aserum albumin amino acid sequence. In some embodiments, the half lifemodulator has an amino acid sequence recited in any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71 or 105.

In some embodiments, the targeting domain binds to a target moleculeselected from the group of myosin, cardiac myosin, DNA,phosphatidylserine, P-selectin, ICAM-1, c-Met (HGF receptor), variantsthereof, fragments thereof, and combinations thereof. In someembodiments, the targeting domain binds to the target molecule with adissociation constant Kd ranging from 10⁻⁶ M to 10−¹²M. The targetingdomain can be selected from the group of annexin, synaptotagmin,anti-phosphatidylserine antibody, PS4A7, lactadherin, anti-myosinantibody, anti-DNA antibody, aDNASI1, aDNASI22, variants thereof,fragments thereof, and combinations thereof. In some embodiments, thetargeting domain has a sequence recited in any one of SEQ ID NOs: 1-2,30-31, 72-73, 76-83 or 85-86. In some embodiments, the antibody is ascFv antibody having a sequence recited in any one of SEQ ID NOs: 1, 2,30, 73, 76-80. In some embodiments, annexin is annexin V and hassequence recited in SEQ ID. NOs 31, 81, 82 or 83. In some embodiments,the targeting domain comprises a sequence recited in any one of SEQ IDNOs: 1, 2, 30, 31 or 72-86.

In some embodiments, the bi-specific fusion protein further comprises aconnector linking the half-life modulator to the fusion protein. Thebi-specific fusion protein can exhibit an in vivo half-life of between 2hours and 6 hours, between 6 hours and 24 hours, greater than 24 hours,or greater than one week.

In some embodiments, the fusion protein promotes cell recruitment,inhibition of apoptosis and/or induction of cell proliferation. In someembodiments, the fusion protein prevents cell damage, promotes cellgrowth, promotes motility of stem cells, and/or promotes differentiationof stem cells. In some embodiments, the fusion protein promotes tissueregeneration. The tissue can be a cardiac tissue, kidney tissue, bone,cartilage, joints, skin, liver tissue, pancreatic tissue, blood cells,lung tissue, or nervous system.

In some embodiments, the fusion protein further comprises a leaderpolypeptide. The leader polypeptide can comprise a sequence recited inany one of SEQ ID NOs: 41, 42, 87-91 or 244.

In some embodiments, the fusion protein further comprises polypeptideaffinity tag. In some embodiments, the affinity tag is at the aminoterminus of the fusion protein, at the carboxy terminus of the fusionprotein, or in the middle of the fusion protein. In some embodiments,the fusion protein comprises a hexahistidine-comprising polypeptide. Thehexahistidine-comprising polypeptide can have a sequence recited in anyone of SEQ ID NOs: 43, 44, or 92-94.

The bi-specific binding agents provided herein are not necessarilylimited to two binding specificities. In certain embodiments, inaddition to the targeting domain, the bi-specific fusion proteincomprises two or more activator domains that are linked directly orindirectly via peptide bonds. In certain embodiments, in addition to theactivator domain, the bi-specific fusion protein comprises two or moretargeting domains that are linked directly or indirectly via peptidebonds.

In other aspects, the present invention provides pharmaceuticalcompositions, comprising a bi-specific fusion protein as described abovein combination with a physiologically acceptable carrier.

Within still further aspects, methods are provided for treatingpathological tissue damage in a patient, comprising administering apharmaceutical composition to a patient suffering from pathologicaltissue damage, and thereby decreasing pathological tissue damage in thepatient.

Aspects of the invention relate to a method of promoting tissueregeneration or survival in a subject, the method comprising (a)providing a bi-specific fusion protein comprising (i) a targeting domainhaving a binding specificity to a target molecule associated with adamaged cell of a tissue, wherein the molecule is intracellular in aviable cell and exposed to the extracellular space in the damaged cell;and (ii) an activator domain having a binding specificity to growthfactor receptor; and (b) administering in a patient in need thereof atherapeutically effective amount of the bi-specific fusion proteinwhereby the targeting domain specifically binds to the target moleculeassociated with the damaged cell of the tissue thereby targeting thebi-specific fusion protein to a first cell of the tissue and wherebyupon exposure of the activator domain to the growth factor receptor, theactivator domain specifically activates the growth factor receptor of asecond cell so as to promote tissue regeneration.

In some embodiments, the method of promoting tissue regeneration orsurvival in a subject comprises (a) providing a bi-specific fusionprotein comprising (i) a targeting domain having a binding specificityto a target molecule; (ii) an activator domain having a bindingspecificity to a receptor; (iii) a half life modulator, wherein the halflife modulator modulates the half life of the bi-specific fusionprotein; and (b) administering in a patient in need thereof atherapeutically effective amount of the bi-specific fusion proteinwhereby the targeting domain specifically binds to the target moleculethereby targeting the bi-specific fusion protein to a first cell of atissue and whereby upon exposure of the activator domain to the growthfactor receptor, the activator domain specifically activates thereceptor of a second cell of the tissue so as to promote tissueregeneration.

In some embodiments, the first and second cells are the same. Yet inother embodiments, the first and second cells are different. In someembodiments, the first cell is a viable cell and the second cell is adamaged cell. Yet in other embodiments, the first cell is a damaged celland the second cell is a viable cell. In some embodiments, the methodfurther comprises administering stem cells to the patient.

In certain embodiments, the pathological tissue damage is heart tissuedamage associated with myocardial infarction. In other embodiments, thepathological tissue damage is kidney tissue damage. In otherembodiments, the pathological tissue damage is in bone, cartilage,joints, skin, liver tissue, pancreatic tissue, blood cells, lung tissue,or nervous system. In certain embodiments, such methods further comprisethe administration of stem cells to the patient.

Also provided herein are nucleic acid molecules encoding a bi-specificfusion protein as described above. In certain embodiments, the nucleicacid molecule is DNA, and the DNA further comprises transcriptional andtranslational regulatory sequences operably linked to the bi-specificfusion protein coding sequence, such that transcription and translationof the coding sequence occurs in at least one eukaryotic cell type.

These and other aspects of the present invention will become apparentupon reference to the following detailed description.

DESCRIPTION OF THE SEQUENCE LISTING

SEQ ID NO:1 is the amino acid sequence of the anti-DNA scFv SI-1.

SEQ ID NO:2 is the amino acid sequence of the anti-DNA scFv SI-22.

SEQ ID NO:3 is the amino acid sequence of a growth factor polypeptidecorresponding to wild type human IGF-I (mature form).

SEQ ID NO:4 is the amino acid sequence of a growth factor polypeptidecorresponding to human IGF-1 with D12A substitution.

SEQ ID NO:5 is the amino acid sequence of a growth factor polypeptidecorresponding to human IGF-1 with E9A substitution.

SEQ ID NO:6 is the amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain N-K1 domain.

SEQ ID NO:7 is the amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain K1 domain.

SEQ ID NO:8 is the amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain N-K2 fusion.

SEQ ID NO:9 is the amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain K2 domain.

SEQ ID NO:10 is the amino acid sequence of a human serum albumin (HSA)linker with C34S and N503Q substitutions.

SEQ ID NO:11 is the nucleic acid sequence of an HSA linker with C34S andN503Q substitutions.

SEQ ID NO:12 is the amino acid sequence of HSA.

SEQ ID NO:13 is the nucleic acid sequence of HSA.

SEQ ID NO:14 is the amino acid sequence of an HSA linker with C34S andN503Q substitutions and a polypeptide connector.

SEQ ID NO:15 is the amino acid sequence of an HSA linker with C34S andN503Q substitutions and a polypeptide connector.

SEQ ID NO:16 is the amino acid sequence of an HSA linker with C34S andN503Q substitutions and a polypeptide connector.

SEQ ID NO:17 is the amino acid sequence of an HSA linker with C34S andN503Q substitutions and a polypeptide connector.

SEQ ID NO:18 is the amino acid sequence of an HSA linker with C34S andN503Q substitutions and a polypeptide connector.

SEQ ID NO:19 is the amino acid sequence of an HSA linker with apolypeptide connector.

SEQ ID NO:20 is the amino acid sequence of an HSA linker with apolypeptide connector.

SEQ ID NO:21 is the amino acid sequence of an HSA linker with apolypeptide connector.

SEQ ID NO:22 is the amino acid sequence of an HSA linker with apolypeptide connector.

SEQ ID NO:23 is the amino acid sequence of an HSA linker with apolypeptide connector.

SEQ ID NO:24 is the amino acid sequence of an HSA linker with C34Ssubstitution, domain I.

SEQ ID NO:25 is the amino acid sequence of an HSA linker, domain II.

SEQ ID NO:26 is the amino acid sequence of an HSA linker with N503Qsubstitution, domain III.

SEQ ID NO:27 is the amino acid sequence of an HSA linker, domain I.

SEQ ID NO:28 is the amino acid sequence of an HSA linker, domain III.

SEQ ID NO:29 is the amino acid sequence of human alpha-fetoprotein.

SEQ ID NO:30 is the amino acid sequence of the anti-phosphatidylserinescFv PS4A7.

SEQ ID NO:31 is the amino acid sequence of human annexin V (AnxV).

SEQ ID NO:32 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain N-K1 domain.

SEQ ID NO:33 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain K1 domain.

SEQ ID NO:34 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain N-K2 domain.

SEQ ID NO:35 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain K2 domain.

SEQ ID NO:36 is an amino acid sequence of a growth factor polypeptidecorresponding to human VEGF alpha monomer.

SEQ ID NO:37 is an amino acid sequence of a growth factor polypeptidecorresponding to human VEGF alpha dimer.

SEQ ID NO:38 is an amino acid sequence of a growth factor polypeptidecorresponding to human FGF2.

SEQ ID NO:39 is an amino acid sequence of a growth factor polypeptidecorresponding to human NRG1 alpha, EGF-like domain.

SEQ ID NO:40 is an amino acid sequence of a growth factor polypeptidecorresponding to human NRG1 alpha, full sequence.

SEQ ID NO:41 is an amino acid sequence of a bi-specific fusion proteinleader polypeptide.

SEQ ID NO:42 is an amino acid sequence of a bi-specific fusion proteinleader polypeptide.

SEQ ID NO:43 is an amino acid sequence of a C-terminalhexahistidine-comprising polypeptide.

SEQ ID NO:44 is an amino acid sequence of a C-terminalhexahistidine-comprising polypeptide.

SEQ ID NO:45 is an amino acid sequence of a HSA linker.

SEQ ID NO:46 is an amino acid sequence of a HSA linker with N-terminaland C-terminal short connector polypeptides.

SEQ ID NO:47 is an amino acid sequence of a HSA linker with N-terminaland C-terminal short connector polypeptides.

SEQ ID NO:48 is an amino acid sequence of a HSA linker with N-terminaland C-terminal short connector polypeptides.

SEQ ID NO:49 is an amino acid sequence of a HSA linker with N-terminaland C-terminal short connector polypeptides.

SEQ ID NO: 50 is an amino acid sequence of a variant of a growth factorpolypeptide corresponding to human FGF2.

SEQ ID NO: 51 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain.

SEQ ID NO: 52 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain K1 domain.

SEQ ID NO: 53 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain N-K2 domain.

SEQ ID NO: 54 is an amino acid sequence of a growth factor polypeptidecorresponding to human HGF alpha chain K2 domain.

SEQ ID NO: 55 is an amino acid sequence of a growth factor polypeptidecorresponding to human NRG1 beta extracellular domain.

SEQ ID NO: 56 is an amino acid sequence of a growth factor polypeptidecorresponding to human NRG1 beta EGF like domain.

SEQ ID NO: 57 is an amino acid sequence of human full length periostin.

SEQ ID NO: 58 is an amino acid sequence of a region of human periostin.

SEQ ID NO: 59 is an amino acid sequence of a growth factor polypeptidecorresponding to human bone morphogenetic protein-2.

SEQ ID NO 60 is an amino acid sequence of a growth factor polypeptidecorresponding to a single chain human bone morphogenetic protein-2.

SEQ ID NO 61 is an amino acid sequence of a growth factor polypeptidecorresponding to vascular endothelial growth factor B.

SEQ ID NO 62 is an amino acid sequence of part of the human vascularendothelial growth factor B.

SEQ ID NO 63 is an amino acid sequence of part of the human vascularendothelial growth factor B.

SEQ ID NO 64 is an amino acid sequence of part of the human vascularendothelial growth factor B.

SEQ ID NO 65 is an amino sequence of domain III of Human Serum Albumin(HSA).

SEQ ID NO 66 is an amino acid sequence of a modified Vitamin D BindingProtein (mVDBP).

SEQ ID NO 67 is an amino sequence of domain III of a modified HumanSerum Albumin.

SEQ ID NO 68 is an amino sequence of human AFP.

SEQ ID NO 69 is an amino sequence of a modified AFP.

SEQ ID NO 70 is an amino acid sequence of the albumin-binding domainhuman antibody (albudAb).

SEQ ID NO 71 is an amino acid sequence of is a monomeric variant form ofFc, named scFc.

SEQ ID NO 72 is an amino acid sequence of synaptotagmin I.

SEQ ID NO 73 is an amino acid sequence of an anti-DNA scFv antibody.

SEQ ID NO 74 is an amino acid sequence of a non-binding synaptotagmin Ivariant.

SEQ ID NO 75 is an amino acid sequence of a non-binding scFv variant(DAscFv).

SEQ ID NO 76 is an amino acid sequence of B7scFv anti-myosin scFvantibody.

SEQ ID NO 77 is an amino acid sequence of FD2 anti-myosin scFv antibody.

SEQ ID NO 78 is an amino acid sequence of MCA1 anti-myosin scFvantibody.

SEQ ID NO 79 is an amino acid sequence of MCB11 anti-myosin scFvantibody.

SEQ ID NO 80 is an amino acid sequence of S3F5 anti-myosin scFvantibody.

SEQ ID NO 81 is an amino acid sequence of a variant of human annexin V(AnxVmC315S).

SEQ ID NO 82 is an amino acid sequence of a variant of human annexin V(AnxVm3).

SEQ ID NO 83 is an amino acid sequence of a variant of human annexin V(AnxVm23).

SEQ ID NO 84 is an amino acid sequence of a non-binding variant of humanannexin V (AnxVm1234).

SEQ ID NO 85 is an amino acid sequence of a variant of lactadherin.

SEQ ID NO 86 is an amino acid sequence of a variant of lactadherin.

SEQ ID NO 87 is an amino acid sequence of alpha mating factor.

SEQ ID NO 88 is an amino acid sequence of app8 leader polypeptide.

SEQ ID NO 89 is an amino acid sequence aga2 signal peptide.

SEQ ID NO 90 is an amino acid sequence SUC2 signal peptide.

SEQ ID NO 91 is an amino acid sequence a synthetic signal peptide.

SEQ ID NO 92 is an amino acid sequence of a hexahistidine tag.

SEQ ID NO 93 is an amino acid sequence of a hexahistidine tag.

SEQ ID NO 94 is an amino acid sequence of a hexahistidine tag.

SEQ ID NOs 95 to 104, and SEQ ID NO 182 to 184 correspond to amino acidsequence of a polypeptide linker.

SEQ ID NO 105 is an amino acid sequence of the proline-, alanine-,and/or serine-rich sequence.

SEQ ID NO 106 is an amino acid sequence of the aDNASI1_mHSA_IGF1 fusionprotein. SEQ ID NO 107 is a nucleic acid sequence of theaDNASI1_mHSA_IGF1 fusion protein.

SEQ ID NO 108 is an amino acid sequence of the aPS4A7_mHSA_IGF1 fusionprotein. SEQ ID NO 109 is a nucleic acid sequence of the of theaPS4A7_mHSA_IGF1 fusion protein.

SEQ ID NO 110 is an amino acid sequence of the aDNASI1_mHSA_HGF(NK1)fusion protein. SEQ ID NO 111 is a nucleic acid sequence of theaDNASI1_mHSA_HGF(NK1) fusion protein.

SEQ ID NO 112 is an amino acid sequence of the aPS4A7_mHSA_HGF(NK1)fusion protein. SEQ ID NO 113 is a nucleic acid sequence of theaPS4A7_mHSA_HGF(NK1) fusion protein.

SEQ ID NO 114 is an amino acid sequence of the AnxVm1234_mHSA_IGF1fusion protein. SEQ ID NO 115 is a nucleic acid sequence of theAnxVm1234_mHSA_IGF1 fusion protein.

SEQ ID NO 116 is an amino acid sequence of the AnxVm1234_mHSA_NRG1b(EGF)fusion protein. SEQ ID NO 117 is a nucleic acid sequence of theAnxVm1234_mHSA_NRG1b(EGF) fusion protein.

SEQ ID NO 118 is an amino acid sequence of the AnxV_mHSA_FGF2 fusionprotein. SEQ ID NO 119 is a nucleic acid sequence of the AnxV_mHSA_FGF2fusion protein.

SEQ ID NO 120 is an amino acid sequence of the AnxV_mHSA_NRG1b(EGF)fusion protein. SEQ ID NO 121 is a nucleic acid sequence of theAnxV_mHSA_NRG1b(EGF) fusion protein.

SEQ ID NO 122 is an amino acid sequence of the FGF2_mHSA_AnxVm1234fusion protein. SEQ ID NO 123 is a nucleic acid sequence of theFGF2_mHSA_AnxVm1234 fusion protein.

SEQ ID NO 124 is an amino acid sequence of the aDNASI1_mHSA_FGF2 fusionprotein. SEQ ID NO 125 is a nucleic acid sequence of theaDNASI1_mHSA_FGF2 fusion protein.

SEQ ID NO 126 is an amino acid sequence of the aDNASI1_mHSA_NRG1b(EGF)fusion protein. SEQ ID NO 127 is a nucleic acid sequence of theaDNASI1_mHSA_NRG1b(EGF) fusion protein.

SEQ ID NO 128 is an amino acid sequence of the AnxV_mHSA_VEGFB(111)fusion protein. SEQ ID NO 129 is a nucleic acid sequence of theAnxV_mHSA_VEGFB(111) fusion protein.

SEQ ID NO 130 is an amino acid sequence of the AnxV_mHSA_VEGFB(167)fusion protein. SEQ ID NO 131 is a nucleic acid sequence of theAnxV_mHSA_VEGFB(167) fusion protein.

SEQ ID NO 132 is an amino acid sequence of the AnxV_mHSA_HGF(NK1) fusionprotein. SEQ ID NO 133 is a nucleic acid sequence of theAnxV_mHSA_HGF(NK1) fusion protein.

SEQ ID NO 134 is an amino acid sequence of the AnxV_mHSA_IGF1 fusionprotein. SEQ ID NO 135 is a nucleic acid sequence of the AnxV_mHSA_IGF1fusion protein.

SEQ ID NO 136 is an amino acid sequence of the IGF1_mHSA_AnxV fusionprotein. SEQ ID NO 137 is a nucleic acid sequence of the IGF1_mHSA_AnxVfusion protein.

SEQ ID NO 138 is an amino acid sequence of the IGF1_mHSA_AnxVm1234fusion protein. SEQ ID NO 139 is a nucleic acid sequence of theIGF1_mHSA_AnxVm1234 fusion protein.

SEQ ID NO 140 is an amino acid sequence of the HGF(NK1)_mHSA_AnxV fusionprotein. SEQ ID NO 141 is a nucleic acid sequence of theHGF(NK1)_mHSA_AnxV fusion protein.

SEQ ID NO 142 is an amino acid sequence of the NRG1b(EGF)_mHSA_AnxVfusion protein. SEQ ID NO 143 is a nucleic acid sequence of theNRG1b(EGF)_mHSA_AnxV fusion protein.

SEQ ID NO 144 is an amino acid sequence of the FGF2_mHSA_AnxV fusionprotein. SEQ ID NO 145 is a nucleic acid sequence of the FGF2_mHSA_AnxVfusion protein.

SEQ ID NO 146 is an amino acid sequence of the VEGFB(167)_mHSA_AnxVfusion protein. SEQ ID NO 14 is a nucleic acid sequence of theVEGFB(167)_mHSA_AnxV fusion protein.

SEQ ID NO 148 is an amino acid sequence of the VEGFB(111)_mHSA_AnxVfusion protein. SEQ ID NO 149 a nucleic acid sequence of theVEGFB(111)_mHSA_AnxV fusion protein.

SEQ ID NO 150 is an amino acid sequence of the IGF1_mHSA_B7scFv fusionprotein. SEQ ID NO 151 is a nucleic acid sequence of theIGF1_mHSA_B7scFv fusion protein.

SEQ ID NO 152 is an amino acid sequence of the IGF1_mHSA_Syt1 fusionprotein. SEQ ID NO 153 is a nucleic acid sequence of the IGF1_mHSA_Syt1fusion protein.

SEQ ID NO 154 is an amino acid sequence of the IGF1_mHSA_aDNASI1 fusionprotein. SEQ ID NO 155 is a nucleic acid sequence of theIGF1_mHSA_aDNASI1 fusion protein.

SEQ ID NO 156 is an amino acid sequence of the NRG1b(EGF)_mHSA_B7scFvfusion protein. SEQ ID NO 157 is a nucleic acid sequence of theNRG1b(EGF)_mHSA_B7scFv fusion protein.

SEQ ID NO 158 is an amino acid sequence of the NRG1b(EGF)_mHSA_Syt1fusion protein. SEQ ID NO 159 is a nucleic acid sequence of theNRG1b(EGF)_mHSA_Syt1 fusion protein.

SEQ ID NO 160 is an amino acid sequence of the NRG1b(EGF)_mHSA_aDNASI1fusion protein. SEQ ID NO 161 is a nucleic acid sequence of theNRG1b(EGF)_mHSA_aDNASI1 fusion protein.

SEQ ID NO 162 is an amino acid sequence of the FGF2_mHSA_B7scFv fusionprotein. SEQ ID NO 163 is a nucleic acid sequence of theFGF2_mHSA_B7scFv fusion protein.

SEQ ID NO 164 is an amino acid sequence of the FGF2_mHSA_Syt1 fusionprotein. SEQ ID NO 165 is a nucleic acid sequence of the FGF2_mHSA_Syt1fusion protein.

SEQ ID NO 166 is an amino acid sequence of the FGF2_mHSA_aDNASI1 fusionprotein. SEQ ID NO 167 is a nucleic acid sequence of theFGF2_mHSA_aDNASI1 fusion protein.

SEQ ID NO 168 is an amino acid sequence of the B7scFv_mHSA_IGF1 fusionprotein. SEQ ID NO 169 is a nucleic acid sequence of theB7scFv_mHSA_IGF1 fusion protein.

SEQ ID NO 170 is an amino acid sequence of the Syt1_mHSA_IGF1 fusionprotein. SEQ ID NO 171 is a nucleic acid sequence of the Syt1_mHSA_IGF1fusion protein.

SEQ ID NO 172 is an amino acid sequence of the aDNASI1_mHSA_IGF1 fusionprotein. SEQ ID NO 173 is a nucleic acid sequence of theaDNASI1_mHSA_IGF1 fusion protein.

SEQ ID NO 174 is an amino acid sequence of the B7scFv_mHSA_NRG1b(EGF)fusion protein. SEQ ID NO 175 is a nucleic acid sequence of theB7scFv_mHSA_NRG1b(EGF) fusion protein.

SEQ ID NO 176 is an amino acid sequence of the Syt1_mHSA_NRG1b(EGF)fusion protein. SEQ ID NO 177 is a nucleic acid sequence of theSyt1_mHSA_NRG1b(EGF) fusion protein.

SEQ ID NO 178 is an amino acid sequence of the B7scFv_mHSA_FGF2 fusionprotein. SEQ ID NO 179 is a nucleic acid sequence of theB7scFv_mHSA_FGF2 fusion protein.

SEQ ID NO 180 is an amino acid sequence of the Syt1_mHSA_FGF2 fusionprotein. SEQ ID NO 181 is a nucleic acid sequence of the Syt1_mHSA_FGF2fusion protein.

SEQ ID NO 185 is an amino acid sequence of the IGF1_mHSA_DAscFv fusionprotein. SEQ ID NO 186 is a nucleic acid sequence of theIGF1_mHSA_DAscFv fusion protein.

SEQ ID NO SEQ ID NOs: 187-190 are the nucleic acid sequences of a growthfactor polypeptide corresponding to human FGF2 (SEQ ID NO:38).

SEQ ID NOs 191-94 are the nucleic acid sequences of a growth factorpolypeptide corresponding to HGF alpha chain N-K1 domain (SEQ ID NO: 6,SEQ ID NO: 32).

SEQ ID NOs 195-197 are the nucleic acid sequences of a growth factorpolypeptide corresponding to wild type human IGF-I (SEQ ID NO 3).

SEQ ID NO 198 is the nucleic acid sequence of a growth factorpolypeptide corresponding to human NRG1 alpha, full sequence (SEQ ID NO40).

SEQ ID NO 199 is the nucleic acid sequence of a growth factorpolypeptide corresponding to human NRG1 alpha, EGF-like domain (SEQ IDNO 39).

SEQ ID NOs 200-202 are the nucleic acid sequences of a growth factorpolypeptide corresponding to human NRG1 beta EGF like domain (SEQ ID NO56).

SEQ ID NO 203 is the nucleic acid sequence of a growth factorpolypeptide corresponding to a region of human periostin (SEQ ID NO 58).

SEQ ID NO 204 is the nucleic acid sequence of a growth factorpolypeptide corresponding to human bone morphogenetic protein-2 (SEQ IDNO 59).

SEQ ID NO 205 is the nucleic acid sequence of a growth factorpolypeptide corresponding to a single chain human bone morphogeneticprotein-2 (SEQ ID NO 60).

SEQ ID NO 206 is the nucleic acid sequence of a growth factorpolypeptide corresponding to a human VEGF alpha monomer (SEQ ID NO 36).

SEQ ID NO 207 is the nucleic acid sequence of a growth factorpolypeptide corresponding to human VEGF alpha dimmer (SEQ ID NO 37).

SEQ ID NOs 208-209 are the nucleic acid sequences of a growth factorpolypeptide corresponding to vascular endothelial growth factor B (SEQID NO 61).

SEQ ID NOs 210-211 are the nucleic acid sequences of a growth factorpolypeptide corresponding to the human vascular endothelial growthfactor B.

SEQ ID NOs 212-214 are the nucleic acid sequences of a half lifemodulator corresponding to human serum albumin (HSA) linker with C34Sand N503Q substitutions (SEQ ID NO 10).

SEQ ID NO 215 is a nucleic acid sequence of a half life modulatorcorresponding to the domain III of a modified Human Serum Albumin (SEQID NO 67).

SEQ ID NO 216 is a nucleic acid sequence of a half life modulatorcorresponding to a modified AFP (SEQ ID NO 69).

SEQ ID NO 217 is a nucleic acid sequence of a half life modulatorcorresponding to the albumin-binding domain human antibody (SEQ ID NO70).

SEQ ID NO 218 is a nucleic acid sequence of a half life modulatorcorresponding to monomeric variant form of Fc, named scFc (SEQ ID NO71).

SEQ ID NO 219 is a nucleic acid sequence of a half life modulatorcorresponding to a modified Vitamin D Binding Protein, mVDBP (SEQ ID NO66).

SEQ ID NOs 220-221 are nucleic acid sequences corresponding to anti-DNAscFv antibody (SEQ ID NO 73).

SEQ ID NO 222 is a nucleic acid sequence corresponding to the anti-DNAscFv SI-1 (SEQ ID NO 1).

SEQ ID NO 223 is a nucleic acid sequence corresponding to the B7scFvanti-myosin scFv antibody (SEQ ID NO 76).

SEQ ID NO 224 is a nucleic acid sequence corresponding to theanti-phosphatidylserine scFv PS4A7 (SEQ ID NO 30).

SEQ ID NOs 225-227 are nucleic acid sequences corresponding to humanannexin V (SEQ ID NO 31).

SEQ ID NO 228 is a nucleic acid sequence corresponding to a variant ofhuman annexin V (C317S, SEQ ID NO 81).

SEQ ID NOs 229-230 are nucleic acid sequences corresponding to a variantof human annexin V AnxVm3, SEQ ID NO 82).

SEQ ID NOs 231-232 are nucleic acid sequences corresponding to anon-internalizing variant of annexin V (AnxVm23, SEQ ID NO 83).

SEQ ID NOs 233-234 are nucleic acid sequences corresponding to anon-binding variant of annexin V (AnxVm1234, SEQ ID NO 84).

SEQ ID NO 235 is a nucleic acid sequence corresponding to synaptotagminI (SEQ ID NO 72).

SEQ ID NOs 236-237 are nucleic acid sequences corresponding tonon-binding scFv variant (DAscFv; SEQ ID No 75).

SEQ ID NOs 238 is a nucleic acid sequence corresponding to a leaderpolypeptide.

SEQ ID NO 239 is a nucleic acid sequence corresponding to alpha matingfactor.

SEQ ID NO 240 is a nucleic acid sequence corresponding to app8 leaderpolypeptide.

SEQ ID NO 241 is a nucleic acid sequence corresponding to aga2 signalpeptide.

SEQ ID NO 242 is a nucleic acid sequence corresponding to SUC2 signalpeptide.

SEQ ID NO 243 is a nucleic acid sequence corresponding to a syntheticsignal peptide.

SEQ ID NO: 244 is an amino acid sequence corresponding to thealpha-factor signal sequence. SEQ ID NO 245 is a nucleic acid sequencecorresponding to the alpha-factor signal sequence.

SEQ ID NO 246 is an amino acid sequence of the DAscFv_mHSA_IGF1 fusionprotein. SEQ ID NO 247 is a nucleic acid sequence corresponding to theDAscFv_mHSA_IGF1 fusion protein.

SEQ ID NO 248 is an amino acid sequence of the DAscFv_mHSA_HGF(NK1)fusion protein. SEQ ID NO 249 is a nucleic acid sequence correspondingto the DAscFv_mHSA_HGF(NK1) fusion protein.

SEQ ID NO 250 is an amino acid sequence of the AnxVm1234_mHSA fusionprotein. SEQ ID NO 251 is a nucleic acid sequence corresponding to theAnxVm1234_mHSA fusion protein.

SEQ ID NO 252 is an amino acid sequence of the AnxV_mHSA fusion protein.SEQ ID NO 253 is a nucleic acid sequence corresponding to the AnxV_mHSAfusion protein.

SEQ ID NO 254 is an amino acid sequence of the NRG1b(EGF)_mHSA_AnxVm1234fusion protein. SEQ ID NO 255 is a nucleic acid sequence correspondingto the NRG1b(EGF)_mHSA_AnxVm1234 fusion protein.

SEQ ID NO 256 is an amino acid sequence of the AnxVm23_mHSA fusionprotein. SEQ ID NO 257 is a nucleic acid sequence corresponding to theAnxVm23_mHSA fusion protein.

SEQ ID NO 258 is an amino acid sequence of the AnxVm1234_mHSA_VEGFB(111)fusion protein. SEQ ID NO 259 is a nucleic acid sequence correspondingto the AnxVm1234_mHSA_VEGFB(111) fusion protein.

SEQ ID NO 260 is an amino acid sequence of the AnxVm1234_mHSA_VEGFB(167)fusion protein. SEQ ID NO 261 is a nucleic acid sequence correspondingto the AnxVm1234_mHSA_VEGFB(167) fusion protein.

SEQ ID NO 262 is an amino acid sequence of the AnxVm1234_mHSA_HGF(NK1)fusion protein. SEQ ID NO 263 is a nucleic acid sequence correspondingto the AnxVm1234_mHSA_HGF(NK1) fusion protein.

SEQ ID NO 264 is an amino acid sequence of the AnxVm1234_mHSA_FGF2fusion protein. SEQ ID NO 265 is a nucleic acid sequence correspondingto the AnxVm1234_mHSA_FGF2 fusion protein.

SEQ ID NO 266 is an amino acid sequence of the mHSA_AnxV fusion protein.SEQ ID NO 267 is a nucleic acid sequence corresponding to the mHSA_AnxVfusion protein.

SEQ ID NO 268 is an amino acid sequence of the mHSA_AnxVm23 fusionprotein. SEQ ID NO 269 is a nucleic acid sequence corresponding to themHSA_AnxVm23 fusion protein.

SEQ ID NO 270 is an amino acid sequence of the mHSA_AnxVm1234 fusionprotein. SEQ ID NO 271 is a nucleic acid sequence corresponding to themHSA_AnxVm1234 fusion protein.

SEQ ID NO 272 is an amino acid sequence of the HGF(NK1)_mHSA_AnxVm1234fusion protein. SEQ ID NO 273 is a nucleic acid sequence correspondingto the HGF(NK1)_mHSA_AnxVm1234 fusion protein.

SEQ ID NO 274 is an amino acid sequence of VEGFB(167)_mHSA_AnxVm1234fusion protein. SEQ ID NO 275 is a nucleic acid sequence correspondingto the VEGFB(167)_mHSA_AnxVm1234 fusion protein.

SEQ ID NO 276 is an amino acid sequence of VEGFB(111)_mHSA_AnxVm1234fusion protein. SEQ ID NO 277 is a nucleic acid sequence correspondingto the VEGFB(111)_mHSA_AnxVm1234 fusion protein.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed incolor. Copies of this patent or patent application publication withcolor drawing(s) will be provided by the Office upon request and paymentof the necessary fee.

FIG. 1 is a SDS-PAGE of purified IGF1_mHSA_AnxV (136),IGF1_mHSA_AnxVm1234 (138), NRG1b(EGF)_mHSA_AnxV (142) andNRG1b(EGF)_mHSA_AnxVm1234 fusion proteins.

FIGS. 2A-2C represent the data obtained by flow cytometry of AnnexinV-FITC plus propidium iodide (PI) apoptosis detection positive controlin apoptotic heart cells.

FIGS. 3A-3B are flow cytometry histograms for the FITC and PI channelsshown in the FIGS. 2 A-2C.

FIGS. 4A-4C represent the data obtained by flow cytometry ofIGF1_mHSA_AnxV plus propidium iodide in apoptotic heart cells.

FIGS. 5A-5B are flow cytometry histograms for the FITC and PI channelsshown in FIGS. 4 A-4C.

FIGS. 6A-6C represent the data obtained by flow cytometry ofIGF1_mHSA_AnxVm1234 plus propidium iodide in apoptotic heart cells.

FIGS. 7A-7B are flow cytometry histograms for the FITC and PI channelsshown in FIGS. 6A-6C.

FIGS. 8A-8C represent the data obtained by flow cytometry of AnnexinV-FITC plus propidium iodide (PI) apoptosis detection positive controlin apoptotic heart cells.

FIGS. 9A-9B are flow cytometry histograms for the FITC and PI channelsshown in FIG. 8 A-8C.

FIGS. 10A-10C represent the data obtained by flow cytometry ofIGF1_mHSA_AnxV plus propidium iodide in apoptotic heart cells, withoutpre-blocking with IGF1.

FIGS. 11A-11B are flow cytometry histograms for the FITC and PI channelsshown in FIGS. 10A-10C.

FIGS. 12A-12C represent the data obtained by flow cytometry ofIGF1_mHSA_AnxVm1234 plus propidium iodide in apoptotic heart cells,without pre-blocking with IGF1.

FIGS. 13A-13B are flow cytometry histograms for the FITC and PI channelsshown in FIG. 12A-12C.

FIGS. 14A-14C represent the data obtained by flow cytometry ofIGF1_mHSA_AnxV plus propidium iodide in apoptotic heart cells, withpre-blocking with 10 min, 800 nM IGF1.

FIGS. 15A-15B are flow cytometry histograms for the FITC and PI channelsshown in FIGS. 14 A-14C.

FIG. 16 is a graph showing that ESC-derived cardiac cells exhibit anapoptotic population, with or without doxorubicin treatment.Ann-HSA=AnxV_mHSA. M1234-Ann-HSA=AnxVm1234_mHSA.

FIGS. 17A-17B represent the data obtained by flow cytometry showing thespecific binding of AnxV_mHSA, and not AnxVm1234_mHSA, to apoptotic,ESC-derived cardiac cells.

FIGS. 18A-18B represent the data obtained by flow cytometry showing thespecific binding of AnxV_mHSA_NRG1b(EGF) to apoptotic ESC-derivedcardiac cells.

FIGS. 19A-19B are graphs showing the specific binding of IGF1_mHSA_Syt1and IGF1_mHSA_AnxV to phosphatidylserine.

FIG. 20A is a graph showing the specific binding of aDNASI1_mHSA_FGF2 toDNA. FIG. 20B is a graph showing the specific binding ofaDNASI1_mHSA_NRG1b(EGF) to DNA. FIG. 20C is a graph showing the specificbinding of IGF1_mHSA_aDNASI1 to DNA.

FIG. 21 is a graph showing stimulation of pAkt in DU145 cells by fusionprotein, NRG1b(EGF)_mHSA_AnxV, and positive-control, NRG1b(EGF).

FIG. 22 is a graph showing stimulation of pAkt in DU145 cells by fusionprotein, AnxV_mHSA_NRG1b(EGF), and positive-control, NRG1b(EGF).

FIG. 23 is a graph showing stimulation of pAkt in DU145 cells by fusionprotein IGF1_mHSA_AnxV, fusion protein IGF1_mHSA_AnxVm1234, andpositive-control, IGF1.

FIG. 24 is a graph showing stimulation of pAkt in DU145 cells by fusionprotein IGF1_mHSA_B7scFv, and positive-control, IGF1.

FIG. 25 is a graph showing the dose-response stimulation of pAkt inheart cells by IGF1 and IGF1_mHSA_AnxV.

FIG. 26 is a graph showing stimulation of pErk in ESC-derivedcardiomyocytes by FGF2 and AnxV_mHSA_FGF2

FIG. 27 is a graph showing the pAkt levels induced by proteins pre-mixedwith apoptotic HL-1 cells (black bars), and with untreated HL-1 cells(gray bars).

FIG. 28A shows a heart dissection used for preparation of 2 hearts pergroup for ELISA measurements. FIG. 28B shows a cross section of sectionB1. Sections B1-infarct and B2 contain most or all of the infarct andnearby border region, while Sections A and B1-remote containpredominantly healthy tissue. LV: Left ventricle.

FIG. 29 is a graph showing measurement of IGF1_mHSA_AnxV and nonbindingIGF1_mHSA_AnxVm1234 fusion proteins in heart at three times afterdosing. Black bars represent the concentration of protein found in theinfarcted plus border regions and gray bars represent the concentrationof protein found in the noninfarcted regions. Two mice per group areshown. Group 2 corresponds to the mice dosed with targeting proteinIGF1_mHSA_AnxV, Group 3 corresponds to the mice dosed with nonbindingvariant IGF1_mHSA_AnxVm1234.

FIGS. 30A-30D are representative photomicrographs fromimmunohistochemical staining of heart sections 24 hr after a mouse wastreated with IGF1_mHSA_AnxV.

FIGS. 31A-31D are representative photomicrographs fromimmunohistochemical staining of heart sections showing infarcted tissueand bordering areas from a mouse treated with IGF1_mHSA_AnxVm1234. Timepoint was 24 hours after dosing.

FIGS. 32A-32D are photomicrographs of controls used to demonstratespecificity of staining of HSA-containing protein or HSA-producingtissue by the primary anti-HSA antibody used in mouse experiments.

FIGS. 33A, 33B, 33C, 33D, 33E, and 33F represent different structures ofcertain bi-specific fusion proteins according to some embodiments.

DETAILED DESCRIPTION OF THE INVENTION

Aspects of the invention are directed to a bi-specific fusion proteinthat comprises two binding domains, a targeting domain having a bindingspecificity to a specific target molecule or target cell and anactivator domain having a binding specificity to a receptor thatmodulates tissue regeneration. In some embodiments, the targeting domainserves to target the bi-specific fusion protein to a target cell ortissue while activator domain serves to activate a cell thereby topromote regeneration of the targeted tissue. As used herein a“bi-specific protein” refers to a fusion protein capable of specificbinding to two or more specific molecules.

In some embodiments, the bi-specific protein comprises (1) a targetingdomain having a binding specificity to a molecule associated with adamaged cell of a tissue, wherein the molecule is intracellular in aviable cell and exposed to the extracellular space in the damaged cell;and (2) an activator domain having a binding specificity to a growthfactor receptor or a cytokine receptor of a cell in the tissue, whereinupon exposure of the activator domain to the growth factor receptor orcytokine receptor, the activator domain binds the growth factor receptoror cytokine receptor so as to modulate regeneration or survival of thetissue.

In some embodiments, the bi-specific fusion protein comprises (1) atargeting domain having a binding specificity to a molecule associatedwith a damaged cell of a tissue, wherein the molecule is intracellularin a viable cell and exposed to the extracellular space in the damagedcell; (2) an activator domain having a binding specificity to a moleculeassociated with the surface of a cell in the tissue, wherein uponexposure of the activator domain to membrane-associated molecule, theactivator domain binds the membrane-associated molecule so as tomodulate regeneration of the tissue and (3) a half life modulatorwherein the half life modulator modulates the half life of thebi-specific fusion protein.

In some embodiments, the bi-specific proteins comprise: (1) a targetingpolypeptide domain that binds to an ischemia-associated molecule; and(2) an activator domain, such as a growth factor polypeptide or acytokine polypeptide so as to promote tissue regeneration or survival.

In some embodiments, the bi-specific fusion protein comprises (1) atargeting domain having a binding specificity to a target moleculeassociated with a tissue; (2) a binding domain (e.g. an activatordomain) having a binding specificity to a molecule associated with thesurface of a cell in the tissue, wherein upon exposure of the bindingdomain to the molecule, the binding domain binds the molecule so as topromote regeneration or survival of the tissue; and (3) a half lifemodulator wherein the half life modulator modulates the half life of thebi-specific fusion protein.

In certain embodiments, the bi-specific fusion protein a half lifemodulator (HLM). In some embodiments, the HLM is a polypeptide. The HLMcan have two termini, an N-terminus and a C-terminus, and is joined atone terminus via a peptide bond to the targeting polypeptide domain andis joined at the other terminus via a peptide bond to the activatordomain. In other embodiments, the half life modulator is joined at oneterminus (N-terminus or C-terminus) to the activator domain or to thetargeting domain. Accordingly, the half life modulator can be at theN-terminus or at the C-terminus of the bi-specific fusion protein. Thehalf life modulator may be joined to the targeting domain or theactivator domain via peptide bonds.

Other aspects of the invention relate to fusion proteins comprising (1)at least one targeting domain having a binding specificity to at leastone target molecule associated with a tissue; (2) at least one bindingdomain (such as an activator domain) having a binding specificity to atleast one molecule associated with the surface of a cell in the tissue,wherein upon exposure of the binding domain to the molecule, the bindingdomain binds the molecule so as to promote regeneration of the tissue;and (3) optionally a half life modulator wherein the half life modulatormodulates the half life of the fusion protein. In some embodiments, thefusion protein comprises two or more targeting domains, each targetingdomain having a binding affinity to a target molecule associated with atissue. Each of the targeting domains may have a same bindingspecificity (e.g., a binding specificity for the same target molecule)or a different binding specificity (e.g., a binding specificity for adifferent target molecule). In some embodiments, the fusion proteincomprises two or more activator domains. Each of the activator domainsmay have the same binding specificity (e.g., a binding specificity tothe same receptor on the cell) or different binding specificity (e.g., abinding specificity for a different receptor on a cell).

One skilled in the art will appreciate that such bi-specific fusionproteins can find use in tissue regeneration. In some embodiments,bi-specific fusion proteins can be used in diseased cells, followingtissue or organ injury or following an event in which the cells of atissue may be damaged. In some embodiments, the bi-specific fusionproteins can activate cells that express one or more growth factorand/or cytokine (e.g., chemokine) and/or integrin. In other embodiments,the bi-specific fusion proteins find use, for example, in recruitingcells that express one or more growth factor and/or cytokine (e.g.,chemokine) receptors and/or integrins (e.g., stem cells, progenitorcells or immune system cells) to tissue following for example, injury,or an event in which the cells of a tissue may be damaged or may becomedysfunctional (e.g. beta cell dysfunction in diabetes). Yet, in vivo,the administration of such bi-specific fusion proteins may be used tofacilitate repair or regeneration of damaged tissue or organ.

In some embodiments, the bi-specific proteins disclosed herein can finduse in modulating tissue survival. For example, the bi-specific proteinscan enhance or maintain the viability of a cell. In some embodiments,the bi-specific fusion proteins can activate the pro-survival or thecell survival pathway. In some embodiments, the bi-specific proteins canmodulate apoptosis.

In some embodiments, bi-specific proteins can have (a) a targetingpolypeptide domain wherein the targeting domain binds to a targetmolecule thereby targeting the bi-specific fusion protein to a firstcell of a tissue and (b) an activator domain having a bindingspecificity to a receptor. Upon exposure of the activator domain to thereceptor, the activator domain can activate the receptor of a secondcell so as to promote cell recruitment, inhibition of apoptosis,induction of cell proliferation, activation of the pro-survival pathway,regeneration, survival of the tissue. One skilled in the art willappreciate that the bi-specific fusion protein can bind to a first cellpopulation and act on the same cell population (e.g. in an autocrinemanner) or on a different cell population (e.g. in a paracrine manner).In some embodiments, the targeting domain binds specifically to a targetmolecule associated with a damaged first cell population and theactivator domain binds specifically to a receptor of a second cellpopulation of viable cells. Yet in some embodiments, the targetingdomain binds specifically to a tissue specific target molecule at thesurface of a first cell population and the activator domain actsspecifically to a second cell population. The first cell can be a viablecell, or an “at risk” cell. As used herein “at risk” cell refers to aviable cell that has not yet undergone apoptosis or is not damaged butis at risk to be damaged.

In some embodiments, the bi-specific protein has two different bindingdomains (such targeting domain and activator domain) which bind todifferent molecule on different cells in a tissue or organ. Yet in otherembodiments, the bi-specific protein has two different binding domainswhich bind to different molecules on the same target cell in a tissue,the targeting domain being selected to bind specifically a target celland the activator domain selected to promote tissue regeneration.

The term “polypeptide” is used herein to refer to a molecule thatconsists of multiple amino acid residues linked by peptide bonds. Thisterm carries no implication as to the number of amino acid residues solinked.

The term “bi-specific,” as used herein, refers to the ability of thefusion protein to interact with two different ligands: a target molecule(bound by the targeting polypeptide domain) and a receptor for theactivator domain. The binding properties of the targeting polypeptidedomain and the activator domain are discussed in more detail below.

As used herein the term “target molecule” refers to any molecule that isassociated with a tissue (e.g. diseased or damaged tissue). A “targetcell” is meant to be a cell to which a bi-specific protein or targetingdomain thereof can specifically bind. Preferred target molecules areexposed or enriched on the exterior of a target cell. In someembodiments, the target molecule is associated with a damaged cell, thetarget molecule being intracellular in a viable or undamaged cell andbeing exposed to the extracellular space in a damaged cell. Suchmolecules include, for example, molecules that are exposed in cells thatundergo necrosis (such as DNA) or apoptosis (e.g., phosphatidylserine),myosin (including the tissue type-specific subtypes thereof), ICAM-1 orP-selectin. Yet in other embodiments, the target molecule is a moleculethat is present or enriched at the surface of a diseased ordysfunctional cell or tissue as compared to the level detected in ahealthy or functional cell or tissue.

Cells are bounded by a plasma membrane (or cell membrane) comprising alipid bilayer. The cell membrane may be considered to have a surfacefacing the cytosol (cytosolic side or interior of the cell) and asurface facing the exterior of the cell, or the extracellular space.Transbilayer movement of anionic phospholipids from the inner to theouter leaflet of the plasma membrane occurs during apoptosis. Theanionic phospholipid-binding protein, such as annexin V, synaptotagmin Ior lactadherin can be used to detect the presence of phosphatidylserineon the outer leaflet of the cell membrane. Phosphatidylserine is aphospholipid, that is usually restricted to the cytosolic side of themembrane in viable or undamaged cells, and that becomes exposed on theouter cell surface or to the extracellular space in apoptosis.Phosphatidylserine has been used as a marker in in vivo imaging studies(see Table 2).

In some embodiments, the target molecule is a “ischemia-associatedmolecule”. An “ischemia-associated molecule” is any molecule that isdetected at a level that is significantly higher (e.g., at least 2-foldhigher) following ischemia or hypoxia. Any suitable binding assay may beused to identify ischemia-associated molecules, including those providedherein. The increased level of molecule that is detected may be theresult of upregulation or decreased turnover, or may be due to increasedaccessibility (e.g., resulting from cell damage). In certainembodiments, the ischemia-associated molecule is detected in a cell ofpost-ischemic tissue at a significantly higher level (e.g., at least2-fold higher) than in a cell of the same tissue that has not undergonean ischemic event (i.e., the molecule is specific to or enriched in thepost-ischemic tissue). In further embodiments, the ischemia-associatedmolecule is associated with cell damage (i.e., the molecule is detectedat a significantly higher level in cells that are damaged than inundamaged cells of the same type). Certain ischemia-associated moleculesare enriched (2-fold or higher) in the heart after an ischemic event (orin a model system that is used to mimic ischemia in the heart). Suchmolecules include, for example, molecules that are exposed on myocytesor other cardiac cells that undergo necrosis (such as DNA) or apoptosis(e.g., phosphatidylserine) or molecules that are enriched in scarredheart tissue, such as collagen (collagen I, III), myosin (including thecell type-specific subtypes thereof), or other extracellular matrixproteins that are enriched in post ischemic hearts. Such molecules canbe identified on the basis of enrichment following ischemia-reperfusionin vivo or in simulated ischemia-reperfusion in vitro, or followingexposure to conditions such as hypoxia, decreased ATP, increasedreactive oxygen species (ROS) or nitric oxide synthase (NOS) production,or serum starvation of cells cultured in vitro.

The Targeting Polypeptide Domain

Binding to the target molecule associated with a tissue (for example,the ischemia-associated molecule) is mediated by the targetingpolypeptide domain. This domain may be any polypeptide sequence thatserves this function. Preferably, binding of the targeting domain to thetarget molecule does not have a biological activity. As used herein,“biological activity” refers to a defined, known activity performed byexposure of a molecule to a domain of the fusion protein.

In some embodiments, the targeting domain is a non-antibody naturallyoccurring polypeptide having a binding affinity to the target molecule,fragment thereof or variant thereof. Yet in other embodiments, thetargeting polypeptide domain comprises one or more antibody variableregions. One skilled in the art will appreciate that any targetingdomain capable of binding directly or indirectly to the target moleculeis contemplated.

In some embodiments, the targeting domain is annexin V (SEQ ID NO: 31),fragment thereof, or variant thereof (SEQ ID NOs: 81-83). Annexin Vbinds to phosphatidylserine (PS). In some embodiments, annexin V ismodified to substitute cysteine 315 with serine or alanine to reducedimer formation. In some embodiments, annexin V is modified to reduceinternalization of Annexin V while maintaining phosphatidylserinebinding affinity. In some embodiments, one or more residues of annexin Vmay be altered to modify binding to achieve a more favored on-rate ofbinding to the target molecule, or a more favored off-rate of binding tothe target molecule. In some embodiments, variants of annexin V in whichD144 was substituted to N, and/or E228 was substituted with A can beused (see Mira, 1997; Kenis, 2004; Kenis 2010 and Ungthum, 2010).

In other embodiments, the targeting domain is synaptotagmin I, fragmentthereof, or variant thereof. Synaptotagmin I (Syt1) has been shown tobind phosphatidylserine in a Ca(2+)-dependent manner with a bindingaffinity of about 5 to 40 nM. In some embodiments, one of the two C2domains of synaptotagmin (e.g., C2B) can be used as the targetingdomain. In some embodiments, the targeting domain is a C2 domain ofCa2+-dependent membrane-targeting proteins involved in signaltransduction or membrane trafficking (e.g., protein kinase C, bloodcoagulation factor V and VIII). In some embodiments, the targetingdomain has sequence recited in SEQ ID. NO: 72. Lactadherin, also knownas milk fat globule-EGF 8, is a 45 kDa phosphatidylserine-bindingglycoprotein secreted by macrophages. Lactadherin contains EGF-likedomains at the amino terminus and two C-domains at the carboxy terminus.Accordingly, in some embodiments, the targeting domain comprises theC-domain of lactadherin, fragment thereof or variant thereof. In someembodiments, one or more residues of the C2 domain may be altered tomodify binding to achieve a more favored on-rate of binding to thetarget molecule, or to achieve a more favored off-rate of binding to thetarget molecule. In some embodiments, the targeting domain has sequencerecited in SEQ ID. NOs: 85 or 86. In some embodiments, the targetingpolypeptide domain comprises a T cell immunoglobulin mucin 1 & 4 (TIMprotein). In other embodiments, the targeting polypeptide domaincomprises a 3G4 antibody or antibody domain capable of bindingindirectly to phosphatidylserine through plasma 2-glycoprotein 1. Yet inother embodiments, the targeting polypeptide domain comprises ananti-phosphatidylserine antibody (e.g. PS4A7, SEQ ID NO. 30) or antibodydomain capable of binding phosphatidylserine.

In some embodiments, the targeting polypeptide domain comprises apolypeptide that binds to the target molecule. Representative suchpolypeptides comprise or have the sequences provided herein as SEQ IDNOs: 31, 72, 81-83 or 85-86. Representative such polypeptides nucleicacid sequences comprise or have the sequences provided herein as SEQ IDNOs: 225-232 or 235.

Native polypeptide can be used as targeting domains. It will beapparent, however, that portions of such native sequences andpolypeptides having altered sequences may also be used, provided thatsuch polypeptides retain the ability to bind the target molecule with anappropriate binding affinity (Kd) as described in more details below.

As used herein, an “antibody” is a protein consisting of one or morepolypeptides substantially encoded by immunoglobulin genes. A typicalantibody is a tetramer that is composed of two identical pairs ofpolypeptide chains, each pair having one “light” (about 25 kD) and one“heavy” chain (about 50-70 kD). “V_(L)” and V_(H)” refer to these lightand heavy chains respectively. An “antibody variable region” is anN-terminal region of an antibody variable chain (V_(L) or V_(H))comprising amino acid residues that are primarily responsible forantigen recognition. Those of ordinary skill in the art are readily ableto identify an antibody variable region and to determine the minimumsize needed to confer antigen recognition. Typically, an antibodyvariable region comprises at least 70 amino acid residues, and morecommonly at least 100 amino acid residues. A polypeptide that comprisesan antibody variable region may (but need not) further comprise otherlight and/or heavy chain sequences, and may (but need not) furthercomprise sequences that are not antibody-derived. It will be apparentthat the sequence of an antibody variable region may benaturally-occurring, or may be modified using standard techniques,provided that the function (antigen recognition) is retained. Certainpolypeptides that comprise an antibody variable region are single chainantibodies (antibodies that exist as a single polypeptide chain), morepreferably single chain Fv antibodies (scFv) in which a variable heavychain region and a variable light chain region are joined together(directly or through a peptide linker) to form a continuous polypeptide.The scFv antibody may be chemically synthesized or may be expressed froma nucleic acid including V_(H)- and V_(L)-encoding sequences eitherjoined directly or joined by a peptide-encoding linker.

“Binding” or “specific binding” are used interchangeably herein andindicates that a bi-specific protein exhibits substantial affinity for aspecific molecule (e.g., targeting domain exhibits substantial affinityfor a target molecule, or an activator domain exhibits substantialaffinity for a molecule associated with the surface of a cell such as areceptor) or a cell or tissue bearing the molecule and is said to occurwhen the fusion protein (or the targeting polypeptide domain thereof orthe activator domain thereof) has a substantial affinity for thespecific molecule and is selective in that it does not exhibitsignificant cross-reactivity with other molecules. Preferred substantialbinding includes binding with a dissociation constant (K_(d)) of 10⁻⁶,10⁻⁷, 10⁻⁸, 10⁻⁹, 10⁻¹⁰, 10⁻¹¹, 10⁻¹² M or better. For example, theK_(d) of an antibody-antigen interaction indicates the concentration ofantibody (expressed as molarity) at which 50% of antibody and antigenmolecules are bound together at thermodynamic equilibrium. Thus, at asuitable fixed antigen concentration, 50% of a higher (i.e., stronger)affinity antibody will bind antigen molecules at a lower antibodyconcentration than would be required to achieve the same percent bindingwith a lower affinity antibody. K_(d) is also the ratio of the kineticon and off rates (k_(on) and k_(off)); i.e., K_(d)=k_(off)/k_(on). Thus,a lower K_(d) value indicates a higher (stronger) affinity. As usedherein, “better” affinities are stronger affinities, and are identifiedby dissociation constants of lower numeric value than their comparators,with a K_(d) of 10⁻¹⁰ M being of lower numeric value and thereforerepresenting a better affinity than a K_(d) of 10⁻⁹M. Affinities better(i.e., with a lower K_(d) value and therefore stronger) than 10⁻⁷M,preferably better than 10⁻⁸M, are generally preferred. Valuesintermediate to those set forth herein are also contemplated, andpreferred binding affinity can be indicated as a range of dissociationconstants, for example preferred binding affinities for antibodiesdisclosed herein are represented by K_(d) values ranging from 10⁻⁶ to10⁻¹²M (i.e., micromolar to picomolar), preferably 10⁻⁷ to 10⁻¹²M, morepreferably 10⁻⁸ to 10⁻¹² M or better. An antibody that “does not exhibitsignificant cross-reactivity” is one that will not appreciably bind toan off-target antigen. For example, in one embodiment, an antibody thatspecifically and selectively binds to cardiac myosin will exhibit atleast a two, and preferably three, or four or more orders of magnitudebetter binding affinity (i.e., binding exhibiting a two, three, or fouror more orders of magnitude lower K_(d) value) for cardiac myosin thanfor myosin molecules other than cardiac myosin or for non-myosinproteins or peptides. Binding affinity and selectivity can be determinedusing any art-recognized methods for determining such characteristics,including, for example, using Scatchard analysis and/or competitive(competition) binding assays.

Binding may be assessed, and K_(d) values determined, using any of avariety of techniques that are well known in the art. For example,binding to an ischemia-associated DNA molecule is commonly assessed bycoating an appropriate solid support (e.g., beads, ELISA plate orBIACORE chip) with target DNA fragments. For a targeting polypeptidedomain that binds to any sequence of DNA, DNA fragments (single ordouble-stranded) of 10 base pairs or larger are immobilized on the solidsubstrate. For a targeting polypeptide domain that binds to a specificsequence or DNA complex (e.g., DNA-histone complex) the appropriatecorresponding target is immobilized. Prior to adding theischemia-associated molecule, non-specific binding sites for protein areblocked with BSA, milk, or any other appropriate blocker. Uncoated wellsor wells coated with a non-target molecule serve as specificitycontrols. Increasing concentrations of the bi-specific fusion protein(or targeting polypeptide domain) are incubated with target-coatedsubstrate or control substrate. A fusion protein or domain that does notbind to the target is also tested as a specificity control. Targetspecific, dose-dependent binding of the bi-specific fusion protein (ortargeting polypeptide domain) is then assessed by measuring the amountof bi-specific fusion protein (or targeting polypeptide domain) bindingto target versus controls as a function of increasing dose usingstandard protocols corresponding to the solid support and bindingtechnology being used. Representative such protocols include thosedescribed in Wassaf et al., Anal. Biochem. 351(2):241-53 (2006); Epub2006 Feb. 10 (BIACORE); and Murray and Brown, J. Immunol. Methods.127(1):25-8 (1990) (ELISA). In addition, studies that vary the amount ofimmobilized target molecule or that include increasing levels of solubletarget molecule as a competitor may also be performed to monitor bindingand specificity.

The binding affinity and kinetic on and off rates for binding to thetarget molecule are measured using standard techniques and compared toother negative control molecules (e.g., fusion protein with irrelevanttargeting polypeptide or fusion protein lacking a targeting polypeptideor fusion proteins with non-binding targeting polypeptide and positivecontrol molecules (e.g., parental antibody that targets the targetmolecule, or other antibodies or antibody fragments that are known tobind to the target molecule). For example, the non-binding targetingpolypeptide can be a non-binding annexin V variant (SEQ ID NO: 84,nucleic acid sequence SEQ ID NOs 233-234), a non-binding synaptotagminvariant (SEQ ID NO: 74) or a non-binding scFv (SEQ ID NO: 75; nucleicacid sequence SEQ ID NOs 236-237)

In certain embodiments, the K_(d) is determined using a biosensor (e.g.,by surface plasmon resonance (e.g., BIAcore) or resonant mirror analysis(IAsys)). Such determinations may be performed as described by Hefta etal., Measuring Affinity Using Biosensors, in “Antibody Engineering: APractical Approach,” McCafferty et al. (eds), pp. 99-116 (OxfordUniversity Press, 1996), and references cited therein. Briefly, kineticon and off rates (k_(on) and k_(off)) are determined using a sensor chipto which the ischemia-associated molecule has been coupled. To evaluateassociation (k_(on)), solutions of different concentrations ofbi-specific fusion protein (or targeting polypeptide domain) flow acrossthe chip while binding is monitored using mass sensitive detection.Using the BIAcore system (GE Healthcare; Piscataway, N.J.), k_(on) isthe slope of the plot of dR/dt versus R, where R is the signal observed.Following binding, dissociation is observed by passing a buffer solutionacross the chip, and k_(off) is determined in an analogous fashion.K_(d) is then calculated using the equation:

K _(d) =k _(off) /k _(on)

In the context of the present invention, a bi-specific fusion proteinbinds to the target molecule if it binds with a K_(d) of less than 10⁻⁸M, preferably less than 10⁻⁷ M, 10⁻⁸ M, 10⁻⁹ M or 10⁻¹⁰ M. In addition,the binding of the bi-specific fusion protein to the target molecule inthis assay is significantly higher (e.g., at least 2-, 10- or 100-foldhigher) than binding of the bi-specific fusion protein to negativecontrols. Preferably, binding to the immobilized target can also becompeted using excess soluble target.

As noted above, certain target molecules are specific to (or enrichedin) damaged cells. Representative target molecules include but are notlimited to phosphatidylserine, DNA, myosin, cardiac myosin, c-Met (HGFreceptor), phosphatidylserine, P-selectin, and ICAM-1. Binding todamaged cells is conveniently demonstrated in vitro using cultured cellsthat are exposed to conditions that induce necrosis or apoptosis. Forexample, necrosis can be induced in cultured cardiomyocytes by simulatedischemia/reperfusion, and monitored using a LDH release assay, or trypanblue assay followed by subtraction of the number of cells undergoingapoptosis, essentially as described in Shan et al., Am. J. Physiol.Cell. Physiol. 294:833-841 (2008). This assay quantitates the total deadcells and the difference between the total and the number of apoptoticcells is attributed to necrosis, as discussed in more detail below.Conditions that induce apoptosis include exposure to H₂O₂, and apoptosiscan be monitored using any of a variety of techniques known in the artincluding, for example, annexin V binding, cleavage of target peptidesequences by known caspases that are activated by apoptosis, or DNAladdering (measured by TUNEL assay, essentially as described inKuramochi, J. Biol. Chem. 279(49): 51141-47 (2004)). Binding to thecells undergoing necrosis or apoptosis may be assessed by addingfluorescently labeled bi-specific fusion protein (or targetingpolypeptide domain) or appropriate control proteins to cells followingthe induction of apoptosis or necrosis. After incubation of the proteinswith the cells for times ranging from a few minutes to one day, thecells are washed and then the cell-bound fluorescence is measured usingimmunofluorescence, flow cytometry, or similar techniques.Alternatively, other methods of detecting the bound bi-specific fusionprotein (or targeting polypeptide domain) may be used, includingradiolabeling or using enzymes conjugated to the bi-specific fusionprotein (or targeting polypeptide domain) or to antibodies that bind tothe fusion protein (or targeting polypeptide domain), which is commonpractice in ELISA protocols. The bi-specific fusion protein (ortargeting polypeptide domain) binds to target cells if significantlyhigher (e.g., 2-fold higher) binding to cells following ischemia (e.g.,cells undergoing necrosis or apoptosis) is detected, as compared tocells that have not experienced injury (e.g., cells not undergoingapoptosis or necrosis).

In vivo targeting may be demonstrated by inducing, for example, ischemiain an animal model and comparing the level of administered bi-specificfusion protein (or targeting polypeptide domain) in a target tissuebefore and after ischemia. In vivo targeting to damaged cells may bedemonstrated by inducing tissue damage in an animal model, administeringthe bi-specific fusion protein (or targeting polypeptide domain), andcomparing the level of bi-specific fusion protein (or targetingpolypeptide domain) in damaged versus undamaged cells. In oneembodiment, the bi-specific fusion proteins are designed to target areasof tissue damage following ischemia-reperfusion injury. In such a case,demonstration of in vivo targeting may be accomplished by inducingtissue damage, preferably by a method that causes ischemia followed byre-establishment of blood supply. Numerous methods are available to dothis in different tissues. For example, blood flow to the hindlimb ofthe mouse can be transiently blocked with a simple tourniquet.Alternatively, temporary clamp on the artery leading into the kidney canbe employed. Ischemia-reperfusion injury can be induced in the heartthrough temporary blockage of the coronary artery as demonstrated inmice, rats, dogs, and pigs. Representative methods for inducing tissuedamage in an animal model are summarized in Table 1.

TABLE 1 Representative Methods used to Induce Ischemia-ReperfusionDamage Organ or Methods used to induce tissue damage Reference HeartMouse: left anterior Dumont et al., Circulation 102(13): 1564-8descending artery (LAD) (2000) clamped for up to 30 to Davis, Proc.Natl. Acad. Sci. USA minutes followed by 23: 103(21): 8155-60 (2006)reperfusion Rat: coronary artery ligation Kidney Mouse: Renal arteryclamped Chen et al., FASEB J. 4(12): 3033-39 (1990) with pediatricsuture for 1-6 hrs Liver Dog: The hepatic pedicle and Miranda et al.,Braz. J. Med. Biol. Res. hepatic artery (close to the 40(6): 857-65(2007) celiac artery) were cross- Kobayashi et al., World J. clampedwith vascular Gastroenterol. 13(25): 3487-92 (2007) clamps. Pig: Detailsin reference Hindlimb Zbinden et al., Am. J. Physiol. Heart Circ.Physiol. 292: H1891-H1897 (2007)

Animal models for ischemia-reperfusion injury are further detailed inthe following references: Greenberg et al., Chapter 7. Mouse models ofischemic angiogenesis and ischemia-reperfusion injury. Methods Enzymol.444:159-74 (2008). Chimenti et al., Myocardial infarction: animalmodels. Methods Mol. Med. 98:217-26 (2004). Black S C, In vivo models ofmyocardial ischemia and reperfusion injury: application to drugdiscovery and evaluation. J. Pharmacol. Toxicol. Methods 43(2):153-67(2000).

The specificity of targeting can be established by comparing thebi-specific fusion protein (or targeting polypeptide domain) depositionin the clamped versus unclamped kidney as shown in Chen et al., FASEB J.4(12): 3033-39 (1990), or in the treated versus untreated hindlimb asshown in Zbinden et al., Am. J. Physiol. Heart Circ. Physiol. 292:H1891-H1897 (2007), using radiolabeled bi-specific fusion protein (ortargeting polypeptide domain). Alternatively, bi-specific fusion protein(or targeting polypeptide domain) can be detected in homogenized tissueusing ELISA, or can be imaged in real time using bi-specific fusionprotein (or targeting polypeptide domain) labeled with the appropriatemetal for imaging (e.g., Tc99, Y or Gd). Specific deposition in thedamaged area of the heart can be measured as described in Dumont et al.,Circulation 102(13):1564-8 (2000). Representative methods fordemonstrating targeting of proteins to damaged tissue are shown in Table2.

TABLE 2 Demonstration of Targeting to Damaged Tissue Damaged organ ortissue targeted Methods used to demonstrate targeted delivery ReferenceHeart Humans: Tc99 labeling of annexin V Hofstra et al., The Lancetfollowed by imaging in humans using 356 (9225): 209-12 SPECT in patientswith myocardial (2000) infarction followed by reperfusion attempts viaangioplasty or thrombolysis Heart Mouse: Fluorescent labeling of annexinV Dumont et al., in murine model of ischemia reperfusion Circulation102(13): with distribution in the myocardium 1564-8 (2000) detectedhistologically Heart Humans: Tc99 labeling of annexin V Hofstra et al.,The Lancet followed by imaging in humans using 356 (9225): 209-12 SPECTin patients undergoing cardiac (2000) transplant rejection Heart Mouse:Fluorescently-labeled growth factor Urbanek, Proc. Natl. imaged in hearttissue using confocal Acad. Sci. USA 102 microscopy (24): 8692-97 (2005)Damaged kidney Radiographs of clamped versus unclamped Chen et al.,FASEB J. targeted using kidney 4(12): 3033-9 (1990) radiolabeledMicroautoradiographs to show localization antibody to to specificcellular structures in the kidney DNA Imaging of whole mouse usingI131-labeled antibody to DNA (versus labeled control) Biodistribution ofI125-labeled antibody to show deposition in non-target tissues

As noted above, certain targeting polypeptide domains comprise anantibody that binds to the target molecule (e.g., DNA, myosin, cardiacmyosin, c-Met, P-selectin, ICAM-1). In some embodiments, the targetingdomain is an anti-myosin antibody (e.g. R11D-10 against human cardiacmyosin, 2G4-sD7 against cardiac myosin heavy chain, 1B2 and 5C2 againsthuman cardiac myosin heavy chain, 2F4 against human cardiac myosin,monoclonal antibodies against myosin, B7 antibody, B7 scFv, or otherantibodies known in the art). In some embodiments, the certain targetingpolypeptide domains comprise an scFv antibody that binds to the targetmolecule. For example, the targeting domain can be an anti-DNA S1-1 scFv(aDNAS11, SEQ ID NOs: 1, or 73) an anti-DNA SI-22 scFv (aDNAS122, SEQ IDNO: 2). Representative such antibodies and scFv antibodies comprise orhave the sequences provided herein as SEQ ID NOs: 1, 2, 30, 73 and76-80. In some embodiments, representative such antibodies and scFvantibodies nucleic acid sequences comprise or have the sequencesprovided herein as SEQ ID NOs 220-224.

It will be apparent that functionally related antibodies may also, oralternatively, be used as a targeting polypeptide domain. Antibodiesinteract with target antigens predominantly through amino acid residuesthat are located in the six heavy and light chain complementaritydetermining regions (CDRs). For this reason, the amino acid sequenceswithin CDRs are more diverse between individual antibodies thansequences outside of CDRs. Because CDR sequences are responsible formost antibody-antigen interactions, it is possible to generate modifiedantibodies that mimic the properties of an original antibody bycombining CDR sequences from one antibody with framework sequences froma different antibody. Such framework sequences can be obtained frompublic DNA databases that include germline antibody gene sequences.

Thus, one or more CDRs of a targeting polypeptide domain sequenceprovided herein can be used to create functionally related antibodiesthat retain the binding characteristics of the original targetingpolypeptide domain. In one embodiment, one or more CDR regions selectedfrom SEQ ID NOs: 1, 2, 30, 73 and 76-80 is combined recombinantly withknown human framework regions and CDRs to create additional,recombinantly engineered, targeting polypeptide domains. The heavy andlight chain variable framework regions can be derived from the same ordifferent antibody sequences. CDR regions are readily identified usingalignments with known sequences in databases such as Vbase and IMGT. Theresulting targeting polypeptide domains share one or more CDRs with thetargeting polypeptide domains of SEQ ID NOs: 1, 2, 30, 73 and 76-80. Incertain embodiments, the targeting polypeptide domain comprises at leastone CDR of a sequence as recited in SEQ ID NO: 1, 2, 30, 73 and 76-80.

It is well known in the art that antibody heavy and light chain CDR3domains play a particularly important role in the bindingspecificity/affinity of an antibody for an antigen. Accordingly, incertain embodiments, antibodies are generated that include the heavyand/or light chain CDR3s of the particular antibodies described herein.The antibodies can further include the heavy and/or light chain CDR1and/or CDR2s of the antibodies disclosed herein.

The CDR 1, 2, and/or 3 regions of the engineered antibodies describedabove can comprise the exact amino acid sequence(s) as those disclosedherein. However, the ordinarily skilled artisan will appreciate thatsome deviation from the exact CDR sequences may be possible,particularly for CDR1 and CDR2 sequences, which can tolerate morevariation than CDR3 sequences without altering epitope specificity (suchdeviations are, e.g., conservative amino acid substitutions).Accordingly, in another embodiment, the engineered antibody may becomposed of one or more CDR's and CDR2s that are, for example, 80%, 90%,95%, 98%, 99% or 99.5% identical to the corresponding CDRs of anantibody named herein.

In another embodiment, one or more residues of a CDR may be altered tomodify binding to achieve a more favored on-rate of binding, or a morefavored off-rate of binding. Using this strategy, an antibody havingultra high binding affinity (e.g., K_(d)=10⁻¹⁰ or less) can be achieved.Affinity maturation techniques, well known in the art, can be used toalter the CDR region(s) followed by screening of the resultant bindingmolecules for the desired change in binding. Accordingly, as CDR(s) arealtered, changes in binding affinity as well as immunogenicity can bemonitored and scored such that an antibody optimized for the bestcombined binding and low immunogenicity are achieved.

Modifications can also be made within one or more of the framework orjoining regions (i.e., non-CDR residues) of the heavy and/or the lightchain variable regions of an antibody, so long as antigen bindingaffinity subsequent to these modifications is not substantiallydiminished.

The Activator Domain

The activator domain is any polypeptide that detectably modulates theactivity of a cellular network or recruit cells from one location toanother. In some embodiments, the activator domain is capable ofactivating signal transduction pathways by binding to a receptor at thesurface a cell. In some embodiments, certain activator domains aregrowth factor polypeptides, cytokine polypeptides (e.g., a chemokinepolypeptide), or any agonist of the receptor or integrin-bindingligands. It will be apparent that such modulation may be an increase ora decrease in the activity of the cellular network such as induction ofproliferation of cells, induction of cell growth, promotion of cellsurvival and/or inhibition of apoptosis. In some embodiments, theactivator domain can recruit other factors or cells (e.g. stem cells).

A growth factor polypeptide detectably modulates activation of a growthfactor receptor (such as HGF or IGF receptor). Certain such polypeptidesare wild-type hepatocyte growth factor (HGF) or HGF alpha chain (e.g.,GENBANK accession number P14210), or derivatives thereof that retain atleast 10% of wild-type biological activity, as determined by measuringactivation of the corresponding growth factor receptor in appropriatetarget cells. Activation may be assessed, for example, by measuringphosphorylation of receptor kinase or downstream proteins, such as AKT,essentially as described by Nishi et al., Proc. Natl. Acad. Sci. USA95:7018-7023 (1998). MTT and CTG assays known in the art may also beused.

In some embodiments, the activator domain is a growth factor. In someembodiments, the activator domain comprises the foregoing or a variantof the protein. Representative activator domains include but are notlimited to fibroblast growth factor (FGF), fibroblast growth factor 1(FGF1), fibroblast growth factor 2 (FGF2, also known as basic fibroblastgrowth factor (bFGF)), fibroblast growth factor 2, 146aa (FGF2-146aa),fibroblast growth factor 2, 157aa (FGF2-157aa), fibroblast growth factor4 (FGF4), fibroblast growth factor 7 (FGF7), epidermal-growth factor(EGF), insulin-like growth factor (IGF), insulin-like growth factor 1(IGF1), insulin-like growth factor 2 (IGF2), hepatocyte growth factor(HGF), hepatocyte growth factor-NK1 domains (HGF-NK1), hepatocyte growthfactor-Kt domain (HGF-K1), hepatocyte growth factor-NK2 domains(HGF-NK2), hepatocyte growth factor-K2 domain (HGF-K2), neuregulin (NRG,also known as heregulin (HRG)), neuregulin-1beta extracellular domain(NRG1beta-ECD), neuregulin-1beta EGF-like domain (NRG1beta-EGF),thymosin, thymosin beta4 (Tbeta4), granulocyte colony-stimulating factor(G-CSF), stem cell factor (SCF, also known as mast cell growth factor(MGF)), periostin, vascular endothelial growth factor (VEGF, also knownas vascular endothelial growth factor-A (VEGF-A)), vascular endothelialgrowth factor-A-121 (VEGF-A-121), vascular endothelial growthfactor-A-165 (VEGF-A-165), vascular endothelial growth factor-B(VEGF-B), vascular endothelial growth factor-B-167 (VEGF-B-167),vascular endothelial growth factor-C(VEGF-C), stromal cell-derivedfactor (SDF), stromal cell-derived factor-1 (SDF-1), stromalcell-derived factor-1alpha (SDF-1alpha), platelet-derived growth factor(PDGF), platelet-derived growth factor-AA (PDGF-AA), platelet-derivedgrowth factor-AB (PDGF-AB), platelet-derived growth factor-BB (PDGF-BB),tetracarcinoma-derived growth factor (TDGF), teratocarcinoma-derivedgrowth factor 1 (TDGF1), nerve growth factor (NGF), beta-nerve growthfactor (beta-NGF), brain-derived neurotrophic factor (BDNF),neurotrophin-3 (NT-3), thrombopoietin (TPO), transforming growthfactor-beta1 (TGF-beta1), transforming growth factor-beta2 (TGF-beta2),bone morphogenic protein (BMP), bone morphogenetic protein-2 (BMP2),single-chain BMP-2 (scBMP2), bone morphogenic protein 3 (BMP3), bonemorphogenic protein 4 (BMP4), activin A, betacellulin, beta-catenin,dickkopf homolog 1 (DKK1), erythropoietin (EPO), growth hormone (GH),heparin-binding EGF-like growth factor (HBEGF), insulin, interleukin(IL), interleukin 6 (IL-6), interleukin 10 (IL-10), interleukin 33(IL-33), leukemia inhibitory factor (LIF), monocyte chemotactic protein1 (MCP1, also known as CCL2), pleiotrophin (PTN), tumor necrosisfactor-alpha (TNF-alpha), Wnt, Wnt1, Wnt2, Wnt3a, Wnt7a, Wnt8a, Wnt11,or antibody having a specificity for the activator receptor, variantthereof, isoforms thereof, fragment thereof, and combinations thereof.In some embodiments, the activator domain is designed to comprise asingle chain of a growth factor or growth factor domain. For example,the activator domain can be designed to comprise two or more copies of agrowth factor domain (e.g. BMP-2) linked together via a linker (e.g.,GGGGSGGGGSGGGGS (SEQ ID NO: 103).

Representative growth factor polypeptides have a sequence as recited inSEQ ID NO: 3-9 32-40, or 50-64, herein. Representative growth factor canbe encoded by the nucleic acid sequences as recited in SEQ ID NOs:187-211, herein.

As discussed above for CDRs of some of the targeting polypeptidedomains, activator domains that share one or more domains, modules, oramino acid sequences with the activator domains or variations of SEQ IDNOs: 3-9, 32-40, or 50-64, are also contemplated. Such domains, modules,or amino acid sequences may be identified and such activator domains maybe constructed using well known techniques. Thus, in certainembodiments, the activator domain comprises at least one domain, module,or amino acid sequence or variation of a sequence as recited in SEQ IDNO: 3-9, 32-40, or 50-64. Similarly, a cytokine polypeptide modulatesactivation of the corresponding cytokine receptor, as determined in thesame fashion.

In certain embodiments, the activator domain is a growth factorpolypeptide, which binds a growth factor receptor on a cell surface.Representative such growth factor receptors are receptors for epidermalgrowth factor (EGF), Neregulin/Heregulin (NRG/HRG), fibroblast growthfactor (FGF), insulin-like growth factor (e.g., IGF-I), platelet-derivedgrowth factor (PDGF), vascular endothelial growth factor (VEGF) andisoforms thereof (e.g., VEGF-A or VEGF-C), teratocarcinoma-derivedgrowth factor 1 (TDGF1), transforming growth factor alpha (TGF-α),transforming growth factor beta (TGF-β) and isoforms thereof e.g.,TGF-β1 or TGF-β2, thrombopoietin (THPO) or periostin. Other suchreceptors include mast/stem cell growth factor receptor (SCFR),hepatocyte growth factor receptor (HGF receptor, i.e., c-Met), ErbB-2,ErbB-3, ErbB-4, high affinity nerve growth factor receptor, BDNF/NT-3growth factors receptor, NT-3 growth factor receptor, or vascularendothelial growth factor receptor 1 (VEGFR-I).

Representative cytokine receptors include, for example, FL cytokinereceptor, receptor for cytokine receptor common gamma chain,interleukin-10 receptor alpha chain, interleukin-10 receptor beta chain,interleukin-12 receptor beta-1 chain, interleukin-12 receptor beta-2chain, interleukin-13 receptor alpha-1 chain, interleukin-13 receptoralpha-2 chain, interleukin-17 receptor; interleukin-17B receptor,interleukin 21 receptor precursor, interleukin-1 receptor type I,interleukin-1 receptor type II, interleukin-2 receptor alpha chain,interleukin-2 receptor beta chain, interleukin-3 receptor alpha chain,interleukin-4 receptor alpha chain, interleukin-5 receptor alpha chain,interleukin-6 receptor alpha chain, interleukin-6 receptor beta chain,interleukin-7 receptor alpha chain, high affinity interleukin-8 receptorA, high affinity interleukin-8 receptor B, interleukin-9 receptor,interleukin-18 receptor 1, interleukin-1 receptor-like 1 precursor,interleukin-1 receptor-like 2, toll-like receptor 1, toll-like receptor2, toll-like receptor 5, CX3C chemokine receptor 1, C-X-C chemokinereceptor type 3, C-X-C chemokine receptor type 4, C-X-C chemokinereceptor type 5, C-X-C chemokine receptor type 6, C-C chemokine receptortype 1, C-C chemokine receptor type 2, C-C chemokine receptor type 3,C-C chemokine receptor type 4, C-C chemokine receptor type 6, C-Cchemokine receptor type 7 precursor, C-C chemokine receptor type 8, C-Cchemokine receptor type 9, C-C chemokine receptor type 10, C-C chemokinereceptor type 11, chemokine receptor-like 2, and chemokine XC receptor.Still other activator domains are receptors for solute carrier organicanion transporter family, member 1A2 (SLCO1A2), sphingosine kinase 1(SPHK1), secreted phosphoprotein 1 (SPP1), also called osteopontin(OPN), tumor protein 53 (TP53), troponin T type 1 (TNNT1), TSPY-likeprotein 2 (TSPYL2), visfatin, WAP four-disulfide core domain 1 (WFDC1),thymosin beta 4, wingless-type MMTV integration site family, member 11(WNT11). Representative activator domains include, for example,resistin, stromal cell-derived factor-1 (SDF-1), signal-inducedproliferation-associated gene 1 (SIPA1), and any of the other ligandslisted above, as well as portions and derivatives of the foregoing thatsubstantially retain the ability to bind to cognate receptors.

Integrins are receptors that mediate attachment of a cell to other cellsor tissue surrounding it. Integrins bind cell surface and extracellularmatrix components such as fibronectin, vitronectin, collagen andlaminin. Representative integrins include for example, α₁β₁, α₂β₁, α₄β₁,α₅β₁, α₆β₁ α_(L)β₂, α_(IIB)β₃, α_(V)β₅, α_(V)β₆, α₆β₄.

As an initial test, binding of a bi-specific fusion protein (oractivator domain thereof) to the appropriate receptor may be assessedusing techniques known in the art. In one representative assay, bindingis demonstrated by coating an appropriate solid support with therecombinant ectodomain of the appropriate receptor. An ectodomain from areceptor not recognized by the activator domain of the bi-specificfusion protein is used as a specificity control. A support substratethat does not have any immobilized receptor is also used as a control.Similar to the methods described above for binding to theischemia-associated molecule, specific, dose-dependent binding toreceptor is demonstrated using standard protocols corresponding to thesolid support and binding technology being used. In addition, studiesthat vary the amount of receptor or that include increasing levels ofsoluble target molecule as a competitor are also performed to monitorbinding and specificity. Alternatively, the bi-specific fusion proteinis immobilized to a support and the binding of the soluble ectodomain ofthe corresponding receptor(s) is used to demonstrate dose-dependent,specific binding.

The binding affinity and kinetic on and off rates for binding of thebi-specific fusion protein to the receptor(s) are also measured usingstandard techniques and compared to other negative control molecules(fusion protein with irrelevant control activator domain, fusion proteinlacking an activator domain) and positive control molecules (recombinantwild-type receptor ligand, such as a growth factor or cytokine). Theequilibrium and kinetic binding parameters of the bi-specific fusionprotein are also compared to the same parameters measured for theun-fused wild-type ligand to determine whether fusion of the ligand toother molecules affects the normal binding of the ligand to itscorresponding receptor. Such information may be used to determine theeffective dose of the bi-specific fusion protein.

A bi-specific fusion protein binds to immobilized growth factor receptoror cytokine receptor with a significantly higher affinity (e.g., atleast 100-fold) than that observed for negative controls. In addition,binding to the immobilized receptor can be competed using excess solublepolypeptide, soluble receptor, or antibodies that bind to polypeptide orreceptor and block their interaction. Preferably, the bi-specific fusionprotein binds to the growth factor or cytokine receptor with an affinitywithin 1000-fold of the native ligand binding to its receptor.

A bi-specific fusion protein (and its activator domain) further has thecapacity to mediate cognate receptor activation. Such activity may beassessed, for example, using a cellular model of ischemia reperfusion,which uses cultured cardiomyocytes such as neonatal rat ventricularmyocytes (NRVM) or cell lines. Simulated ischemia (SI) is generallyinitiated by metabolic inhibitors (deoxyglucose and dithionite) andmetabolites (high potassium, lactate, low pH) or by hypoxia in ananaerobic chamber. Reperfusion is simulated by resuspension in anoxygenated buffer. An in vitro adult cardiomyocyte pellet model ofischemia has been developed that provides the two primary components ofischemia—hypoxia and metabolite accumulation—in the absence of anyexogenous metabolic inhibitors or metabolites. Table 3 showsrepresentative methods for demonstrating the ability of a bi-specificfusion protein to prevent damage of cardiomyocytes, promote growth,motility or differentiation of cardiac stem cells and/or promote repairof damaged tissue.

TABLE 3 Activity Assessment Methods Aspect Assay Reference Localizationand Detection of activator domain in cell Davis, Proc Natl retentionkinetics lysate by ELISA Acad Sci USA of activator Detection ofactivator domain in cells 103(21): 8155-60 domain by immunofluorescence(flow cytometry or (2006) microscopic) Urbanek, Proc. Natl. Acad. Sci.USA 102 (24): 8692-97 (2005) Signaling by Detection of phospho-akt orphospho- Davis, Proc Natl activator domain ERK in cells by flowcytometry, Acad Sci USA immunofluorescence, ELISA, phospho- 103(21):8155-60 labeling, or Western (2006) Urbanek, Proc. Natl. Acad. Sci. USA102 (24): 8692-97 (2005) Protection of cells AnnexinV binding by againstapoptosis immunofluorescence or flow cytometry following hypoxiaDetection of caspase activity or other cell TUNEL-assay (reduced numberof stressor TUNEL-positive cells) DNA laddering Cell viabilityEnhancement of cardiomyocyte viability following exposure to H₂O₂.Number of rod- shaped cells pPCR assessment of gene expressionProtection of cells Reduced necrotic area by H&E staining againstnecrosis Reduction in scar Reduction in number of fibroblastic cells information infarct area Reduction collagen deposition Reduction in othermatrix proteins associated with scar formation Migration of CSC Timedependent increase in c-kit+, sca-1+, Urbanek, Proc. Natl. into theinfarct MDR1+ cell numbers and numbers Acad. Sci. USA 102 areaundergoing transition to small myocytes (24): 8692-97 (2005) MyocyteFrequency of distribution of myocyte sizes Urbanek, Proc. Natl.mechanics and cell Peak shortening Acad. Sci. USA 102 fusion: Velocityof shortening and relengthening (24): 8692-97 Assessment of cell fusion(number of X (2005) chromosomes) Cardiac functional Comparison ofMI-treated versus MI- Urbanek, Proc. Natl. assessment untreated animalsAcad. Sci. USA 102 LVEDP (24): 8692-97 LVDP (2005) +dp/dT LV WeightChamber Volume Diastolic Wall Stress Survival Myocardial Composition ofregenerated myocardium Urbanek, Proc. Natl. regeneration Assessment ofBrdU+ cells in infarct area in Acad. Sci. USA 102 treated versusuntreated animals (24): 8692-97 Myosin+ cells in the infarct area intreated (2005) versus untreated animals Cardiac structural Infarct sizeUrbanek, Proc. Natl. Fibrosis Acad. Sci. USA 102 Cardiomyocytehypertrophy (24): 8692-97 (2005)

Native growth factors and cytokines can be used as activator domains. Itwill be apparent, however, that portions of such native sequences andpolypeptides having altered sequences may also be used, provided thatsuch polypeptides retain the ability to activate the cognate receptor(e.g., using one of the assays discussed below), such polypeptidesdetectably activate the receptor, and preferably activate the receptorto a degree that is at least 1% (preferably at least 10%) of thatobserved for the native ligand. Certain activator domains that bind togrowth factor receptors are provided herein in SEQ ID NOs: 3-9, 32-40,and 50-64. Activity of fusion proteins comprising such sequences is wellknown in the art (e.g., Hashino et al., J. Biochem. 119(4):604-609(1996); Nishi et al., Proc. Natl. Acad. Sci. USA 95:7018-23 (1998)).

An activator domain for a particular application may be selected basedon the desired therapeutic outcome. For example, an activator domainthat comprises FGF2, VEGF alpha, or a portion or derivative thereof,that substantially retains the ability to bind to cognate receptor, maygenerally be used to increase angiogenesis. To increase survival and forstem cell differentiation (regenerative) purposes, activator domainsthat comprise IGF, HGF or NRG1 (or a portion or derivative thereof) maybe used.

In some cases, it may be desirable to assess the activity of both theactivator domain and the targeting polypeptide simultaneously. An ELISAmay be conveniently used for this purpose.

The substrate of the targeting polypeptide (e.g., DNA) is adsorbed tothe ELISA plate, which is then blocked with appropriate BSA containingbuffers. The bi-specific fusion protein is then added, followed byaddition of recombinant substrate for the activator domain (e.g., if theactivator is a growth factor, then the substrate is recombinant cognatereceptor or receptor fragment (ectodomain)). This substrate is eitherfluorescently labeled for detection or detected using a labeled antibodyto a region of the receptor that does not significantly affect ligandbinding.

The in vivo activity of the bi-specific fusion protein is generallyassessed by detecting signaling changes in molecules that are regulatedby the activator domain of the bi-specific fusion protein. Thistypically involves changes in cell surface receptor phosphorylationstatus or downstream mediators such as phospho-AKT or phospho-ERK asdetected by flow cytometry, immunofluorescence, ELISA, phospho-labeling,or Western analysis of treated tissues. Other functional assessmentsinclude tests for the number of viable cells by staining andmorphological identification, level of apoptosis by annexin V binding(via immunofluorescence) or flow cytometry, detection of caspaseactivity, TUNEL-assay (reduced number of TUNEL-positive cells) or DNAladdering. In each case, a bi-specific fusion protein functions in vivoif it induces a significant (e.g., at least 2-fold) change in the level,functional activity, or phosphorylation of the regulated moleculedetected by the assay.

The repair of damaged tissue in a patient can be assessed using anyclinically relevant standard. For example, repair of infarcted tissuecan be measured by quantitation of cell number, such as the number ofmyocytes, fibroblast, or amount of scarring, or with functional assaysfor output or structural aspects of heart function including, LVEDP,LVDP, +dp/dT, LV Weight, Chamber Volume, and Diastolic Wall Stress.Methods for such assessments are well known and amply described in theliterature. In general, a bi-specific fusion protein is said to repairdamaged tissue if it results in a significant (e.g., at least 2-fold)change in any such clinical assessment.

Half Life Modulator

One skilled in the art would appreciate that bi-specific proteins usedin therapeutic applications may not exhibit optimal serum half lives dueto their relatively low molecular weight. In some therapeuticapplications, it may therefore be desirable to modulate the half life ofthe bi-specific proteins. In some embodiments, to achieve accumulationof the bi-specific protein to the diseased injured or damaged area of anorgan, the bi-specific protein is conjugated with a half-life modulator.Such half-life modulators can increase the in vivo half life of thefusion proteins. For example, the half life of the bi-specific proteinscomprising the half life modulator is about 1 hour, 2 hours, 3 hours, 4hours, 5 hours, 6 hours or greater. In some embodiments, the half lifeof the bi-specific proteins comprising the half life modulator is about24 hours, or greater. In some embodiments, the half life of thebi-specific proteins comprising the half life modulator is about a weekor greater.

The targeting polypeptide domain and activator domain may be directlyjoined via a peptide bond. In some embodiments, they may be joined via ahalf-life modulator. In preferred embodiments, the half-life modulatoris a polypeptide. Accordingly, the half-life modulator can have twotermini, an N-terminus and a C-terminus. In some embodiments, thehalf-life modulator is joined at one terminus via a peptide bond to thetargeting polypeptide domain and is joined at the other terminus via apeptide bond to the activator domain. In certain embodiments, the linkeris joined at the N-terminus to the C-terminus of the targetingpolypeptide domain and at the C-terminus to the N-terminus of theactivator domain. In other embodiments, the linker is joined at theC-terminus to the targeting polypeptide domain and at the N-terminus tothe activator domain. Yet, in other embodiments, the half-life modulatoris joined at one of the termini of the bi-specific protein. For example,in some embodiments, the half-life modulator is joined at the C-terminusto the N-terminus of the activator domain. In other embodiments, thehalf-life modulator is joined at the C-terminus of the targeting domain.In other embodiments, the half-life modulator can be joined at theN-terminus to the C-terminus of the activator domain. Yet in otherembodiments, the half-life modulator can be joined at the N-terminus tothe C-terminus of the targeting domain.

In some embodiments, the half-life modulator is designed to drive thesize of the bi-specific fusion protein beyond about 70 kDa or equivalentradius to minimize renal clearance. In some embodiments, the half-lifemodulator is designed to extend the half-life of the bi-specific fusionprotein through FcRn receptor-mediated recycling or through binding toserum components such as Human Serum Albumin (HSA).

Preferably, the half-life modulator is non-immunogenic in humans. Thehalf-life modulator can be a human serum protein or a derivative thereofthat retains at least 50% sequence identity over a region that consistsof at least 100 consecutive amino acids. As used herein “sequenceidentity” means, in the context of comparing a polynucleotide or apolypeptide sequence to a reference sequence, that the polynucleotide orpolypeptide sequence is the same or has a specified percentage ofnucleotides or residues that are the same at the corresponding locationswithin the reference sequence when the polynucleotide or polypeptidesequences are optimally aligned.

In some embodiments, the half-life modulator can be modified byglycosylation of one or more glyscosylation site present in thehalf-life modulator. For example, the following amino acids: asparagine,serine, threonine can be added or removed to alter the glycosylation ofthe half-life modulator. In some embodiments, glycosylation of thehalf-life modulator in the bi-specific protein can modulate thehalf-life of the bi-specific protein. In some embodiments, the half-lifemodulator sequence is modified to reduce glycosylation. Suchmodification comprising the substitution of Asn (N) by Gln (Q) or Ala(A), and/or the substitution of Ser (S) or Thr (T) by Ala (A).

Human serum albumin (HSA) has a naturally long serum half life, in partdue to its binding to FcRN and recycling. HSA is the most abundantprotein in the blood and has a demonstrated safety in humans. In someembodiments, the asparagine at position 503 of HSA, which may bedeamidated and decrease half life, can be removed by the N503Qsubstitution. In some embodiments, the cysteine C34 of HSA may besubstituted to serine or alanine (S or A) to remove the free cysteineand minimize alternate disulfide-bond formation. In some embodiments,the half-life modulator is a modified version of the domain III(mHSA_dIII) of a modified HSA with the N503Q substitution and anadditional terminal glycine. Such a modified version retains the HSAproperty of binding to FcRn and increased serum half life. In someembodiments, the half-life modulator comprises at least 100 consecutiveamino acids that are at least 70%, 80%, 85%, 90% or 95% identical to ahuman serum albumin amino acid sequence (SEQ ID NO: 12). In someembodiments, the half-life modulator comprises the sequence recited inSEQ ID NOs: 10, 12, 24-28, 65, or 67. In some embodiments, the half-lifemodulator nucleic acid sequence comprises the sequence recited in SEQ IDNOs: 212-215.

In some embodiments, the half-life modulator comprises at least 100consecutive amino acids that are at least 70%, 80%, 85%, 90% or 95%identical to a human alpha-fetoprotein (AFP) amino acid sequence (SEQ IDNOs: 29, 68). In some embodiments, the N-linked glycosylation site ofthe AFP is removed by the N251Q substitution. In some embodiments, thehalf-life modulator comprises the sequence recited in SEQ ID NOs: 29,68, or 69. In some embodiments, the half-life modulator nucleic acidsequence comprises the sequence recited in SEQ ID NO: 216.

In some embodiments, the half-life modulator comprises at least 100consecutive amino acids that are at least 70%, 80%, 85%, 90% or 95%identical a vitamin D-binding protein (VDBP) amino acid sequence. Insome embodiments, the N-linked glycosylation site of the VDBP can beremoved by the N288Q or N288T substitution. In some embodiments, thehalf-life modulator comprises the sequence recited in SEQ ID NO: 66. Insome embodiments, the half-life modulator nucleic acid sequencecomprises the sequence recited in SEQ ID NO: 219.

In some embodiments, the half-life modulator comprises at least 100consecutive amino acids that are at least 70%, 80%, 85%, 90% or 95%identical to a human transthyretin (TTR) amino acid sequence. In someembodiments, the transthyretin is modified to remove the N118N-glycosylation site. In some embodiments, the half-life modulator is amonomeric form of TTR.

In some embodiments, the half-life modulator comprises at least 100consecutive amino acids that are at least 70%, 80%, 85%, 90% or 95%identical to a human Fc amino acid sequence. The Fc domain of anantibody has a natural capability to bind FcRn, resulting in an extendedhalf-life. In some embodiments, the Fc domain of an antibody isengineered not to bind Fc(gamma)R. In an exemplary embodiment, the Fcdomain is engineered to substitute N397 with Q (N297Q variant). In someembodiments, the half-life modulator is a monomeric variant form of Fc,named scFc. For example, the subset of IgG heavy chain which naturallydimerizes to form Fc is hinge-CH2-CH3. In some embodiments, the Fcdomain is engineered to form a single chain by linking the hinge-CH2-CH3with a flexible linker such as GGGGSGGGGSGGGGSGGGGS (SEQ ID NO: 104) tocreate a hinge-CH2-CH3-linker-hinge-CH2-CH3 chain. In an exemplaryembodiment, the single chain Fc (scFc) is engineered to substitute N397with Q and C220 with S (N297Q, C220S). In some embodiment, the scFcdomain comprises a sequence recited in SEQ ID NO: 71. In someembodiments, the half-life modulator nucleic acid sequence comprises thesequence recited in SEQ ID NO: 218.

In some embodiments, the half-life modulator comprises at least 100consecutive amino acids that are at least 70%, 80%, 85%, 90% or 95%identical to a PASylation amino acid sequence. PASylation are proline-,alanine-, and/or serine-rich sequences that mimic PEGylation (seeWO2008/155134). Polypeptide stretches of proline, alanine, and/or serineform semi-structured three-dimensional domains with large hydrodynamicradius, thereby reducing clearance of fusion proteins. In someembodiments, the PASylation amino acid sequence is about 200, 300, 400,500 or 600 amino acids long. For example, the PASylation is a 20 timesrepeat of the amino acid sequence ASPAAPAPASPAAPAPSAPA (SEQ ID NO: 105).

In some embodiments, the half-life modulator comprises at least 100consecutive amino acids that are at least 70%, 80%, 85%, 90% or 95%identical to an albumin-binding domain human antibody (albudAb) aminoacid sequence (SEQ ID NO: 70). Albumin-binding domain antibodies canincrease the fusion protein half-life by binding non-covalently to serumalbumin (see WO2008/096158). In some embodiments, the albumin-bindingdomain human antibody is engineered to remove the C-terminal arginine toremove the Lys-Arg Kex2 protease site. In some embodiments, thehalf-life modulator nucleic acid sequence comprises the sequence recitedin SEQ ID NO: 217.

Representative such half-life modulators include those recited in anyone of SEQ ID NOs: 10, 12, 14-29, 45-49, 65-71 or 105.

In some embodiments, the half-life modulators can be modified tosubstitute the cysteine residues to serine or alanine residues to reducethe ability to form disulfide bonds.

The half-life modulator may be incorporated or conjugated into abi-specific fusion protein alone or using a short (e.g., from 2 to 20amino acid residues) connector polypeptide. In some embodiments, theconnector polypeptide is present at the N-terminus, at the C-terminus orat both the N-terminus and the C-terminus of the half-life modulator atone or both ends. Suitable short connector polypeptides for use at theN-terminal end of the linker include, for example, dipeptides such as-Gly-Ala-(GA) and -Ala-Ser-(AS). Suitable short connector polypeptidesfor use at the C-terminal end of the linker include, for example,dipeptides such as -Leu-Gln-(LQ) and -Thr-Gly-(TG). In some embodiments,the connectors are longer than 2 amino acids. For example, theconnectors are 5, 10, 5, 20, 30, 40, 50, 60, 70, 80, 90, 100 amino acidslong. Preferably, such connectors are flexible (for exampleglycine-rich) or structured (e.g., alpha-helix rich). In someembodiments, the connectors or polypeptide linkers have a sequencerecited in SEQ ID NOs: 41-42, 87-91 or 244. In some embodiments, theconnectors are based on human proteins such as transthyretin.

SEQ ID NOs: 46-49 recite the half-life modulator of SEQ ID NO: 45 withrepresentative connector dipeptides at both the N- and C-termini. Itwill be apparent, however, that such short connector polypeptides andconnector recited in SEQ ID NOs: 95-104 or 182-184, if present, may belocated at either one or both termini of the half-life modulator.

Certain preferred half-life modulators provide a prolonged half-life ofthe bi-specific fusion protein, as compared to fusion protein withouthalf-life modulator. The effect of a half-life modulator on half-lifecan be evaluated using an assay that determines stability underphysiological conditions. For example, bi-specific fusion protein can beincubated at 37° C. in serum (e.g., human serum) for 120 hours, withsamples removed at the start of incubation and every 24 hoursthereafter. Binding assays as described above are then performed todetect the level of functional bi-specific fusion protein at each timepoint. This level is then compared to the level of bi-specific fusionprotein constructed without half-life modulator (or using a differenthalf-life modulator) to provide a half-life comparison.

Optional Elements and Representative Bi-Specific Fusion Proteins

It will be apparent that elements in addition to those described abovemay optionally be included in the bi-specific fusion proteins providedherein. Such elements may be present for a variety of purposes,including to facilitate expression, preparation or purification of thebi-specific fusion protein, or to perform targeting functions. Forexample, an N-terminal leader polypeptide may be present. Representativeleader polypeptides comprise or have a sequence recited in anyone of SEQID NOs: 41-42, 87-91, or 244. A bi-specific fusion protein may also, oralternatively, comprise a polyhistidine (e.g., hexahistidine) tag tofacilitate purification. Such a tag comprises at least six histidineconsecutive amino acid residues, and may be located at the C- orN-terminus. In certain embodiments, a hexahistidine tag is included atthe C-terminus of the bi-specific fusion protein. Additional amino acidresidues may also be present at the junction of the polyhistidine to theremainder of the bi-specific fusion protein. Certain bi-specific fusionproteins provided herein comprise a C-terminal polyhistidine-comprisingpolypeptide as recited in SEQ ID NOs: 43, 44, or 92-94.

Certain bi-specific fusion proteins have a general structure thatsatisfies one of the following structure (shown from N-terminal toC-terminal, left to right) shown in FIGS. 33A, 33B, 33C, 33D, 33E and33F.

Representative bi-specific fusion proteins comprise (from N-terminal toC-terminal):

(a) a leader polypeptide (e.g., comprising or having a sequence recitedin SEQ ID NOs: 41-42, 87-91 or 244);(b) a targeting polypeptide domain (e.g., comprising or having asequence recited in SEQ ID NOs: 1, 2, 30, 31, 72, 73, 76-83 or 85-86);(c) a optional short connector polypeptide;(d) a half-life modulator (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71, or 105;(e) a optional short connector polypeptide;(f) an activator domain (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:3-9, 32-40, and 50-64); and(g) a polyhistidine-comprising polypeptide (e.g., ahexahistidine-comprising polypeptide, such as a polypeptide comprisingor having a sequence recited in SEQ ID NO:43-44 or 92-94).

For example, certain such bi-specific fusion proteins comprise(N-terminal to C-terminal):

(a) a leader polypeptide (e.g., comprising or having a sequence recitedin SEQ ID NOs: 41-42, 87-91 or 244);(b) a targeting polypeptide domain (e.g., comprising or having asequence recited in SEQ ID NOs: 1, 2, 30, 31, 72, 73, 76-83 or 85-86);(c) a half-life modulator (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71, or 105;(d) an optional short connector polypeptide;(e) an activator domain (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:3-9, 32-40, and 50-64); and(f) a polyhistidine-comprising polypeptide (e.g., ahexahistidine-comprising polypeptide, such as a polypeptide comprisingor having a sequence recited in SEQ ID NO:43-44 or 92-94).

Other bi-specific fusion proteins comprise (from N-terminal toC-terminal):

(a) a leader polypeptide (e.g., comprising or having a sequence recitedin SEQ ID NOs: 41-42, 87-91 or 244);(b) an activator domain (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:3-9, 32-40, and 50-64);(c) an optional short connector polypeptide;(d) a half-life modulator (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71, or 105);(e) an optional short connector polypeptide;(f) a targeting polypeptide domain (e.g., comprising or having asequence recited in SEQ ID NOs: 1, 2, 30, 31, 72, 73, 76-83 or 85-86);(g) a poly-histidine-comprising polypeptide (e.g., ahexahistidine-comprising polypeptide, such as a polypeptide comprisingor having a sequence recited in SEQ ID NO:43-44 or 92-94).

Still further bi-specific fusion proteins comprise (from N-terminal toC-terminal):

(a) a leader polypeptide (e.g., comprising or having a sequence recitedin SEQ ID NOs: 41-42, 87-91 or 244);(b) a half-life modulator (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71, or 105;(c) an optional short connector polypeptide;(d) an activator domain (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:3-9, 32-40, and 50-64);(e) an optional short connector polypeptide;(f) a targeting polypeptide domain (e.g., comprising or having asequence recited in SEQ ID NOs: 1, 2, 30, 31, 72, 73, 76-83 or 85-86);(g) a poly-histidine-comprising polypeptide (e.g., e.g., ahexahistidine-comprising polypeptide, such as a polypeptide comprisingor having a sequence recited in SEQ ID NO:43-44 or 92-94).

Still further bi-specific fusion proteins comprise (from N-terminal toC-terminal):

(a) a leader polypeptide (e.g., comprising or having a sequence recitedin SEQ ID NOs: 41-42, 87-91 or 244);(b) a half-life modulator (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71, or 105);(c) an optional short connector polypeptide;(d) a targeting polypeptide domain (e.g., comprising or having asequence recited in SEQ ID NOs: 1, 2, 30, 31, 72, 73, 76-83 or 85-86);(e) an optional short connector polypeptide;(f) an activator domain (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:3-9, 32-40, and 50-64);(g) a poly-histidine-comprising polypeptide (e.g., ahexahistidine-comprising polypeptide, such as a polypeptide comprisingor having a sequence recited in SEQ ID NO:43-44 or 92-94).

Still further bi-specific fusion proteins comprise (from N-terminal toC-terminal):

(a) a leader polypeptide (e.g., comprising or having a sequence recitedin SEQ ID NOs: 41-42, 87-91 or 244);(b) a targeting polypeptide domain (e.g., comprising or having asequence recited in SEQ ID NOs: 1, 2, 30, 31, 72, 73, 76-83 or 85-86);(c) an optional short connector polypeptide;(d) an activator domain (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:3-9, 32-40, and 50-64);(e) an optional short connector polypeptide;(f) a half-life modulator (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71, or 105);(g) a poly-histidine-comprising polypeptide (e.g., ahexahistidine-comprising polypeptide, such as a polypeptide comprisingor having a sequence recited in SEQ ID NO:43-44 or 92-94).

Still further bi-specific fusion proteins comprise (from N-terminal toC-terminal):

(a) a leader polypeptide (e.g., comprising or having a sequence recitedin SEQ ID NOs: 41-42, 87-91 or 244);(b) an activator domain (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:3-9, 32-40, and 50-64);© a optional short connector polypeptide;(d) a targeting polypeptide domain (e.g., comprising or having asequence recited in SEQ ID NOs: 1, 2, 30, 31, 72, 73, 76-83 or 85-86);(e) a optional short connector polypeptide;(f) a half-life modulator (e.g., comprising or having a sequence recitedin any one of SEQ ID NOs:10, 12, 14-29, 45-49, 65-71, or 105);(g) a poly-histidine-comprising polypeptide (e.g., ahexahistidine-comprising polypeptide, such as a polypeptide comprisingor having a sequence recited in SEQ ID NO:43-44 or 92-94).

In some embodiments, the short connector polypeptide comprises asequence recited in SEQ ID NOs: 95-104 or 182-184.

In some embodiments, the optional short connector polypeptide is adipeptide (Gly-Ala; Ala-Ser; Leu-Gln; Thr-Gly) or polypeptide having anamino acid sequence listed in SEQ ID NOs: 95-104 and 182-184.

Representative bi-specific fusion protein include, but are not limitedto, aDNASI1_mHSA_IGF1, aPS4A7_mHSA_IGF1, aDNASI1_mHSA_HGF(NK1),aPS4A7_mHSA_HGF(NK1), AnxV_mHSA_FGF2, AnxV_mHSA_NRG1b(EGF),aDNASI1_mHSA_FGF2, aDNASI1_mHSA_NRG1b(EGF), AnxV_mHSA_VEGFB(111),AnxV_mHSA_VEGFB(167), AnxV_mHSA_HGF(NK1), AnxV_mHSA_IGF1,IGF1_mHSA_AnxV, HGF(NK1)_mHSA_AnxV, NRG1b(EGF)_mHSA_AnxV,FGF2_mHSA_AnxV, VEGFB(167)_mHSA_AnxV, VEGFB(111)_mHSA_AnxV,IGF1_mHSA_B7scFv, IGF1_mHSA_Syt1, IGF1_mHSA_aDNASI1,NRG1b(EGF)_mHSA_B7scFv, NRG1b(EGF)_mHSA_Syt1, NRG1b(EGF)_mHSA_aDNASI1,FGF2_mHSA_B7scFv, FGF2_mHSA_Syt1, FGF2_mHSA_aDNASI1, B7scFv_mHSA_IGF1,Syt1_mHSA_IGF1, aDNASI1_mHSA_IGF1, B7scFv_mHSA_NRG1b(EGF),Syt1_mHSA_NRG1b(EGF), B7scFv_mHSA_FGF2, Syt1_mHSA_FGF2. Representativebi-specific fusion proteins can have a sequence recited in SEQ ID NOs;106, 108, 110, 112, 118, 120, 124, 126, 128, 130, 132, 134, 136, 140,142, 144, 146, 148, 150, 152, 154, 156, 158, 160, 162, 164, 166, 168,170, 172, 174, 176, 178, 180, or can be encoded by the nucleic acidhaving a sequence recited in SEQ ID NOs: 107, 109, 111, 113, 119, 121,125, 127, 129, 131, 133, 135, 137, 141, 143, 145, 147, 149, 151, 153,155, 157, 159, 161, 163, 165, 167, 169, 171, 173, 175, 179, or 181.

Representative bi-specific fusion protein comprising a non-bindingtargeting polypeptide include, but are not limited to, DAscFv_mHSA_IGF1,DAscFv_mHSA_HGF(NK1), AnxVm1234_mHSA_VEGFB(111),AnxVm1234_mHSA_VEGFB(167), AnxVm1234_mHSA_HGF(NK1), AnxVm1234_mHSA_IGF1,AnxVm1234_mHSA_NRG1b(EGF), AnxVm1234_mHSA_FGF2, HGF(NK1)_mHSA_AnxVm1234,NRG1b(EGF)_mHSA_AnxVm1234, FGF2_mHSA_AnxVm1234,VEGFB(167)_mHSA_AnxVm1234, VEGFB(111)_mHSA_AnxVm1234, IGF1_mHSA_DAscFv,NRG1b(EGF)_mHSA_DAscFv, FGF2_mHSA_DAscFv, DAscFv_mHSA_NRG1b(EGF), andDAscFv_mHSA_FGF2. Representative bi-specific fusion proteins can have asequence recited in SEQ ID NOs 114, 116, 122, 138, 185, 246, 248, 254,258, 260, 262, 264, 272, 274, 276 or can be encoded by nucleic acidhaving a sequence recited in SEQ ID NOs: 115, 116, 123, 139, 186, 247,249, 255, 259, 261, 263, 265, 273, 275 or 277.

Preparation of Bi-specific Fusion Proteins

Bi-specific fusion proteins may be synthesized using standardtechniques, including liquid- and solid-phase peptide synthesis andrecombinant DNA techniques. For solid phase synthesis, the C-terminalamino acid of the sequence is attached to an insoluble support, and theremaining amino acids are added in sequence. For polypeptides longerthan about 50 amino acids, shorter regions may be synthesized in thisfashion and then condensed to form the longer polypeptide. Methods offorming peptide bonds by activation of a carboxyl terminal end (e.g., bythe use of the coupling reagent N, N′-dicyclohexylcarbodiimide) are wellknown in the art.

For recombinant DNA techniques, DNA encoding the bi-specific fusionprotein is prepared chemically or by isolating and ligating DNA encodingeach portion of the fusion protein. The DNA coding for each segment ofthe bi-specific fusion protein may be isolated from known genes orsynthesized de novo. Methods for direct chemical synthesis of DNA arewell known in the art, and such syntheses are routinely performed usingan automated synthesizer. Chemical synthesis produces a single strandedpolynucleotide, which is converted into double stranded DNA byhybridization with a complementary sequence or using DNA polymerase.While chemical synthesis of DNA is generally limited to sequences thatare shorter than the bi-specific fusion protein, it will be apparentthat the full bi-specific fusion protein may be obtained by ligation ofshorter sequences in frame. Alternatively, DNA sequences encoding thebi-specific fusion protein are prepared by cloning. Cloning techniquesare well known in the art, and are amply described, for example, bystandard references such as Sambrook et al., Molecular Cloning: ALaboratory Manual (3^(rd) ed.), Cold Spring Harbor Laboratory Press(2001). Portions of the DNA may be ligated together in frame to generatethe full length coding sequence.

Once the DNA encoding the bi-specific fusion protein is obtained, theDNA may be cloned into a vector for expression in a prokaryotic oreukaryotic host cell. Techniques for incorporating DNA into such vectorsare well known to those of ordinary skill in the art. Within such anexpression vector, the DNA encoding the bi-specific fusion protein isoperably linked to the nucleotide sequences necessary for expression(e.g., a suitable promoter and, if necessary, a terminating signal). Apromoter is a nucleotide sequence (typically located 5′ to the codingsequence) that directs the transcription of adjacently linked codingsequences. A terminating signal may be a stop codon to end translationand/or a transcription termination signal. Additional regulatoryelement(s) (e.g., enhancer elements) may also be present within anexpression vector. Such a vector is preferably a plasmid or viralvector. Preferably, an expression vector further comprises a selectablemarker, which confers resistance to a selection. This allows cells tostably integrate the vector into their chromosomes and grow to formfoci, which in turn can be cloned and expanded into cell lines. Avariety of selectable markers are known in the art, including, forexample, genes that provide resistance to ampicillin, methotrexate,mycophenolic acid, the aminoglycoside G-418, hygromycin and puromycin.Those of ordinary skill in the art are knowledgeable in the numerousexpression systems available for expression of proteins including E.coli, other bacterial hosts, yeast, and various higher eukaryotic cellssuch as the COS, CHO, HeLa and myeloma cell lines.

Host cells are transformed or transfected with the vector that comprisesthe DNA encoding the bi-specific fusion protein using standard methods.Expression in the host cell results in transcription of the DNA into thecorresponding mRNA, followed by translation of the mRNA to generate thebi-specific fusion protein.

Once expressed, the bi-specific fusion protein can be purified accordingto standard procedures, including, for example, ammonium sulfateprecipitation or affinity column chromatography. Substantially purecompositions of at least about 90 to 95% homogeneity are preferred, and98 to 99% or more homogeneity is most preferred for pharmaceutical uses.Once purified, partially or to homogeneity as desired, if to be usedtherapeutically, the polypeptides should be substantially free ofendotoxin.

Pharmaceutical Compositions

The present invention also provides pharmaceutical compositionscomprising at least one bi-specific fusion protein as described herein,together with at least one physiologically acceptable carrier. Suchcompositions may be used for treating patients who are suffering from,or at risk for, tissue damage, in order to prevent tissue damage, or torepair or regenerate damaged tissue. Such patients include, for example,patients who have experienced myocardial infarction, kidney damage,and/or ischemic stroke. If desired, other active ingredients may also beincluded within the pharmaceutical composition, such as stem cells orother agents that facilitate repair of damaged tissue.

As used herein, the term “physiologically acceptable” means approved bya regulatory agency of the Federal or a state government or listed inthe U.S. Pharmacopeia or other generally recognized pharmacopeia for usein animals, and more particularly in humans. The term “carrier” refersto a diluent, adjuvant, excipient, or vehicle with which the bi-specificfusion protein is administered. Physiologically acceptable carriers canbe sterile liquids, such as water and oils, including those ofpetroleum, animal, vegetable or synthetic origin (e.g., peanut oil,soybean oil, mineral oil, or sesame oil). Water is a preferred carrierwhen the pharmaceutical composition is administered intravenously.Saline solutions and aqueous dextrose and glycerol solutions can also beemployed as liquid carriers, particularly for injectable solutions.Suitable pharmaceutical excipients include, for example, starch,glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silicagel, sodium stearate, glycerol monostearate, talc, sodium chloride,dried skim milk, glycerol, propylene, glycol, water and ethanol. Thecomposition, if desired, can also contain minor amounts of wetting oremulsifying agents, or pH buffering agents.

Pharmaceutical compositions may be formulated for any appropriate mannerof administration, including, for example, parenteral, intranasal,topical, oral, or local administration, such as by a transdermal means,for prophylactic and/or therapeutic treatment. These compositions cantake any of a variety of well known forms that suit the mode ofadministration, such as solutions, suspensions, emulsions, tablets,pills, capsules, powders, aerosols and sustained-release formulations.The composition can be formulated as a suppository, with traditionalbinders and carriers such as triglycerides. Oral formulation can includestandard carriers such as pharmaceutical grades of mannitol, lactose,starch, magnesium stearate, sodium saccharine, cellulose, magnesiumcarbonate, etc. Examples of suitable pharmaceutical modes ofadministration and carriers are described in “Remington: The Science andPractice of Pharmacy,” A. R. Gennaro, ed. Lippincott Williams & Wilkins,Philadelphia, Pa. (21^(st) ed., 2005).

Commonly, the pharmaceutical compositions provided herein areadministered parenterally (e.g., by intravenous, intramuscular, orsubcutaneous injection), or by oral ingestion or topical application.For parenteral administration, the bi-specific fusion protein can eitherbe suspended or dissolved in the carrier. A sterile aqueous carrier isgenerally preferred, such as water, buffered water, saline orphosphate-buffered saline. In addition, sterile, fixed oils may beemployed as a solvent or suspending medium. For this purpose any blandfixed oil may be employed, including synthetic mono- or diglycerides. Inaddition, fatty acids such as oleic acid find use in the preparation ofinjectible compositions. Pharmaceutically acceptable auxiliarysubstances may also be included to approximate physiological conditions,such as pH adjusting and buffering agents, tonicity adjusting agents,dispersing agents, suspending agents, wetting agents, detergents,preservatives, local anesthetics and buffering agents.

In one preferred embodiment, the pharmaceutical composition isformulated for intravenous administration to a patient (e.g., a human).Typically, compositions for intravenous administration are solutions insterile isotonic aqueous buffer. Where necessary, the composition mayalso include a solubilizing agent and a local anesthetic such aslignocaine to ease pain at the site of the injection. Generally, theingredients are supplied either separately or mixed together in unitdosage form, for example, as a dry lyophilized powder or water freeconcentrate in a sealed (e.g., hermetically sealed) container such as anampoule or sachette indicating the quantity of active agent. Where thecomposition is to be administered by infusion, it can be dispensed withan infusion bottle containing sterile pharmaceutical grade water orsaline. Where the composition is administered by injection, an ampouleof sterile water for injection or saline can be provided so that theingredients may be mixed prior to administration.

Compositions intended for oral use may be presented as, for example,tablets, troches, lozenges, aqueous or oily suspensions, dispersiblepowders or granules, emulsion, hard or soft capsules, or syrups orelixirs. Such compositions may further comprise one or more componentssuch as sweetening agents flavoring agents, coloring agents andpreserving agents. Tablets contain the active ingredient in admixturewith physiologically acceptable excipients that are suitable for themanufacture of tablets. Such excipients include, for example, inertdiluents, granulating and disintegrating agents, binding agents andlubricating agents. Formulations for oral use may also be presented ashard gelatin capsules wherein the active ingredient is mixed with aninert solid diluent, or as soft gelatin capsules wherein the activeingredient is mixed with water or an oil medium. Aqueous suspensionscomprise the active materials in admixture with one or more excipientssuitable for the manufacture of aqueous suspensions. Such excipientsinclude suspending agents and dispersing or wetting agents. Dispersiblepowders and granules suitable for preparation of an aqueous suspensionby the addition of water provide the active ingredient in admixture witha dispersing or wetting agent, suspending agent and one or morepreservatives.

Oily suspensions may be formulated by suspending the active ingredientsin a vegetable oil (e.g., arachis oil, olive oil, sesame oil or coconutoil) or in a mineral oil such as liquid paraffin. Pharmaceuticalcompositions may also be in the form of oil-in-water emulsions. The oilyphase may be a vegetable oil or a mineral oil or mixture thereof.Suitable emulsifying agents include, for example, naturally-occurringgums, naturally-occurring phosphatides and anhydrides.

Pharmaceutical compositions may be sterilized by conventionalsterilization techniques, or may be sterile filtered. Sterile aqueoussolutions may be packaged for use as is, or lyophilized, the lyophilizedpreparation being combined with a sterile aqueous carrier prior toadministration. The pH of an aqueous pharmaceutical compositiontypically will be between 3 and 11, more preferably between 5 and 9 orbetween 6 and 8, and most preferably between 7 and 8, such as 7 to 7.5.

Bi-specific fusion proteins provided herein are generally present withina pharmaceutical composition at a concentration such that administrationof a single dose to a patient delivers a therapeutically effectiveamount. A therapeutically effective amount is an amount that results ina discernible patient benefit, such as detectable repair or regenerationof damaged tissue or diminution of symptoms of tissue damage.Therapeutically effective amounts can be approximated from the amountssufficient to achieve detectable tissue repair or regeneration in one ormore animal models exemplified in Table 3. Nonetheless, it will beapparent that a variety of factors will affect the therapeuticallyeffective amount, including the activity of the bi-specific fusionprotein employed; the age, body weight, general health, sex and diet ofthe patient; the time and route of administration; the rate ofexcretion; any simultaneous treatment, such as a drug combination; andthe type and severity of the tissue damage in the patient undergoingtreatment. Optimal dosages may be established using routine testing, andprocedures that are well known in the art. Dosages generally range fromabout 0.5 mg to about 400 mg of bi-specific fusion protein per dose(e.g., 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 50 mg, 100 mg, 200 mg, 300 mg,or 400 mg per dose). In general, compositions providing dosage levelsranging from about 0.1 mg to about 100 mg per kilogram of body weightper day are preferred. In certain embodiments, dosage unit forms containbetween from about 10 mg to about 100 mg of bi-specific fusion protein.

Pharmaceutical compositions may be packaged for treating or preventingtissue damage (e.g., for treatment of myocardial infarction or kidneydamage). Packaged pharmaceutical preparations include a containerholding a therapeutically effective amount of at least onepharmaceutical composition as described herein and instructions (e.g.,labeling) indicating that the contained composition is to be used fortreating tissue damage (such as myocardial infarction or kidney damage)in a patient. Pharmaceutical compositions may be packaged in multiplesingle dose units, each containing a fixed amount of bi-specific fusionprotein in a sealed package. Alternatively, the container may holdmultiple doses of the pharmaceutical composition.

Methods of Treatment

The pharmaceutical compositions can be administered to a patient(preferably a mammal such as a cow, pig, horse, chicken, cat, dog, ormore preferably a human) to treat pathological tissue damage in thepatient. Within the context of the present invention, the term“treatment” encompasses both prophylactic and therapeuticadministration. In prophylactic applications, a pharmaceuticalcomposition as described herein is administered to a patient susceptibleto or otherwise at risk for developing pathological tissue damage, inorder to prevent, delay or reduce the severity of tissue damage. Intherapeutic applications, treatment is performed in order to reduce theseverity of the pathological tissue damage or regenerate tissue afterdamage. In some embodiments, the pharmaceutical composition can beadministered in combination with other therapeutic compositions.

Representative pathological tissue damage includes heart tissue damage(e.g., damage associated with myocardial infarction), kidney tissuedamage and tissue damage following a ischemic stroke (e.g. cerebralischemia, also known as brain ischemia, critical limb ischemia or otherischemia). In some embodiments, the pharmaceutical composition can beused to protect tissue from damage and/or to regenerate tissue and/orblood supply after tissue or organ damage.

In some embodiments, the pharmaceutical composition can be administeredto prevent, delay, reduce or treat autoimmune diseases, for example,Systemic Lupus Erythematosus (SLE), also known as Lupus. SLE is anautoimmune disease where many tissues or systems are attacked and becomeinflamed, for example, joints, skin, liver, kidneys, blood cells, heart,lungs, nervous system, blood vessels. The immune system producesantibodies against self, particular against nuclear proteins and DNA. Insome embodiments, the pharmaceutical compositions can be administered toa subject in need thereof to protect tissue from damage and regeneratingtissue after damage. In some embodiments, the pharmaceutical compositioncan be administered in combination with existing immune-suppression orother treatments.

In some embodiments, the pharmaceutical compositions can be administeredto a subject in need thereof to prevent, delay, reduce or treat Type Idiabetes. In type I diabetes, the body's own immune system destroys theinsulin-producing beta cells in the pancreas. In some embodiments, thepharmaceutical compositions can be administered to a subject in needthereof to regenerate beta cells. In some embodiments, thepharmaceutical compositions can be administered in combination with TypeI diabetes treatments known in the art.

In some embodiments, the pharmaceutical compositions can be administeredto a subject in need thereof to prevent, delay, reduce or treat tissueor organ degeneration. For example, the pharmaceutical compositions canbe used to treat brain, spinal cord or nerve degeneration such asAlzheimer's disease, Parkinson's disease, Multiple sclerosis, orAmyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.In some embodiments, the pharmaceutical compositions can be administeredin combination with existing treatments known in the art.

In some embodiments, the pharmaceutical compositions can be administeredto a subject in need thereof to prevent, delay, reduce or treat boneand/or cartilage associated disease. In some embodiments, thepharmaceutical compositions can be used to regenerate bone and/orcartilage tissues. The pharmaceutical compositions can be administeredin combination with existing treatments known in the art.

Any of a variety of known delivery systems can be used to administer abi-specific fusion protein including, for example, encapsulation inliposomes, microparticles, microcapsules, recombinant cells capable ofexpressing the bi-specific fusion protein, receptor-mediated, or aretroviral or other nucleic acid vector. The bi-specific fusion proteinmay be administered by any convenient route, for example by infusion orbolus injection, by absorption through epithelial or mucocutaneouslinings (e.g., oral mucosa, rectal and intestinal mucosa, etc.), and maybe administered together with other biologically active agents.Administration can be systemic or local. In addition, it may bedesirable to introduce the bi-specific fusion protein into the centralnervous system by any suitable route, including intraventricular andintrathecal injection; intraventricular injection may be facilitated byan intraventricular catheter, for example, attached to a reservoir, suchas an Ommaya reservoir. Pulmonary administration can also be employed,e.g., by use of an inhaler or nebulizer, and formulation with anaerosolizing agent.

In a specific embodiment, it may be desirable to administer thebi-specific fusion protein of the invention locally to the area in needof treatment; this may be achieved by, for example, local infusionduring surgery, topical application (e.g., in conjunction with a wounddressing after surgery), by injection, by means of a catheter, by meansof a suppository, or by means of an implant, said implant being of aporous, non-porous, or gelatinous material, including membranes, such assialastic membranes, or fibers. In another embodiment, a vesicle, suchas a liposome, can be used to deliver the bi-specific fusion protein. Inyet another embodiment, the bi-specific fusion protein is delivered in acontrolled release system; for example, such a controlled release systemmay be placed at or near the therapeutic target (e.g., an organ of thebody that has experienced or is at risk for tissue damage). The use ofsuch delivery systems is well known to those of ordinary skill in theart.

In some embodiments, the bi-specific fusion proteins provided herein areeffective for treating pathological tissue damage at least in part dueto their ability to recruit stem cells to the damaged tissue. In certaincases, sufficient stem cells may reside within the patient (e.g.,resident cardiac stem cells). In certain embodiments, however, it may bebeneficial to co-administer stem cells (e.g., bone marrow-derivedautologous stem cells). Such stem cells may be administered before orafter the bi-specific fusion protein, or may be administeredsimultaneously (either in the same pharmaceutical composition or inseparate compositions).

In some embodiments, the bi-specific proteins provided herein areeffective in enhancing tissue survival. In some embodiments, thebi-specific proteins can be administered and target a specific tissue ororgan (e.g heart). The bi-specific proteins can then accumulate in thespecific tissue or organ (e.g. heart as opposed to another organ)through binding of the targeting domain to the tissue associated targetmolecule. Once bound to the target molecule, the bi-specific fusionprotein can dissociate from the target molecule, move away andre-associate to a target molecule, a growth factor receptor, or cytokinereceptor of a different cell of the tissue in a paracrine-like manner(e.g. a damaged cell or an “at risk” cell).

As noted above, the optimal dose depends on certain factors known in theart, but generally ranges from about 0.5 mg to about 400 mg ofbi-specific fusion protein per dose (e.g., 10 mg, 50 mg, 100 mg, 200 mg,300 mg, or 400 mg per dose). A dose of bi-specific fusion protein(within a pharmaceutical composition as described above) can beadministered therapeutically to a patient one or more times per hour,day, week, month, or year (e.g., 2, 4, 5, 6, 7, 8, 9, 10, 11, or 12times per hour, day, week, month, or year). More commonly, a single doseper day or per week comprising an amount of bi-specific fusion proteinranging from about 0.1 mg to about 100 mg per kilogram of body weight isadministered.

In other embodiments, a pharmaceutical composition comprising abi-specific fusion protein may be administered to a patient in a dosagethat ranges from about 0.1 mg per week to about 2500 mg per week, about0.1 mg per week to about 10 mg per week, about 1 mg per week to about100 mg per week, about 10 mg per week to about 500 mg per week, about100 mg per week to about 2500 mg per week, about 10 mg per week to about100 mg per week, or about 100 mg per week to about 1000 mg per week.Alternatively, a pharmaceutical composition comprising a bi-specificfusion protein may be administered at a dose that ranges from about 0.1mg every other day to about 500 mg every other day, about 1 mg everyother day to about 75 mg every other day, about 10 mg every other day toabout 50 mg every other day, or about 20 mg every other day to about 40mg every other day. A pharmaceutical composition comprising abi-specific fusion protein may alternatively be administered at a dosethat ranges from about 0.1 mg three times per week to about 100 mg threetimes per week, about 1 mg three times per week to about 75 mg threetimes per week, about 10 mg three times per week to about 50 mg threetimes per week, or about 20 mg three times per week to about 40 mg threetimes per week.

In further embodiments of, a pharmaceutical composition comprising abi-specific fusion protein is administered to a mammal (e.g., a human)continuously for 1, 2, 3, or 4 hours; 1, 2, 3, or 4 times a day; everyother day or every third, fourth, fifth, or sixth day; 1, 2, 3, 4, 5, 6,7, 8, 9, or 10 times a week; biweekly; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28,29, or 30 times a month; bimonthly; 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10times every six months; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,15, 16, 17, 18, 19, or 20 times a year; or biannually. It will beapparent that a pharmaceutical composition comprising a bi-specificfusion protein may, but need not, be administered at differentfrequencies during a therapeutic regime.

The following Examples are offered by way of illustration and not by wayof limitation. Unless otherwise specified, all reagents and solvents areof standard commercial grade and are used without further purification.Using routine modifications, the procedures provided in the followingExamples may be varied by those of ordinary skill in the art to make anduse other bi-specific fusion proteins and pharmaceutical compositionswithin the scope of the present invention.

EXAMPLES Example 1. Preparation of a Representative Bi-Specific FusionProtein

A bi-specific fusion protein in which targeting polypeptide domain bindsto DNA and the activator domain is NRG1 is prepared. The two domains arejoined by a modified human serum albumin (HSA) linker. The NRG1 isrecombinantly fused to the amino terminus of the HSA linkerincorporating a short connector polypeptide and the anti-DNA scFv isrecombinantly fused to the carboxy terminus of the modified HSA linkerincorporating an additional short connector polypeptide. The modifiedHSA linker contains two amino acid substitutions. A cysteine residue atposition 34 of native HSA is mutated to serine in order to reducepotential protein heterogeneity due to oxidation at this site. Anasparagine residue at amino acid 503 of native HSA, which may besensitive to deamidation, resulting in decreased pharmacologichalf-life, is mutated to glutamine. The modified HSA linker confers anextended circulating half-life on the bi-specific fusion protein.

Example 2. In Vitro Activity of a Bi-Specific Fusion Protein

The activity of both components of the representative bi-specific fusionprotein prepared in Example 1 (in which the targeting polypeptide domainbinds to DNA and the activator domain is NRG1) are tested using an ELISAdesigned to give activity only when both arms of the bi-specific fusionprotein are bound to their substrates simultaneously. The ELISA isperformed essentially as described in Stokes et al., J. Clin. Pathol.35(5): 566-573 (1982) and Gripenberg et al., Scand. J. Immunol.1:151-157 (1978). More specifically, 1 to 50 ng/ml solution of thebi-specific fusion protein in PBS is added to the wells of a platepre-adsorbed with DNA (Anti-DS-DNA antibody ELISA kit (Alpha DiagnosticInternational, Dist by AutogenBioclear, UK) and incubated and washedaccording to manufacturer's directions until the step in which thedetection antibody is added. At this stage, 100 μl of 1-50 ng/mlsolution of Biotinylated goat anti-human NRG1-B1 (R&D Systems BAF377)(antibody to the ‘activator arm’) in PBS/1% BSA/0.05% Tween is added toall wells and incubated for 1 hr at room temperature, washed in PBS with0.05% Tween-20. 100 μl of Streptavidin-HRP (1:200 dilutions of stock 2ug/ml, (R&D Systems 890803)) diluted in PBS is added to each well andincubated 30 min at room temperature. After a final wash in PBS with0.05% Tween-20, 100 μl of SuperSignal ELISA Pico ChemiluminescentSubstrate (as per manufacturer's instructions, Pierce, cat #34077) isadded and luminescence (representative of positive signal) is measuredon Fusion Microplate reader (Packard) or similar instrument.

The amount of signal detected is significantly higher (at least 100-foldhigher) in the wells with bi-specific fusion protein than in wellswithout DNA or negative controls that contain a dead arm (i.e., does notcontain an activator domain or targeting polypeptide domain). Inaddition, the signal is seen to vary with the amount of bi-specificfusion protein added to the wells.

Example 3. In Vivo Activity of a Bi-Specific Fusion Protein

The in vivo activity of the representative bi-specific fusion proteinprepared in Example 1 is determined by detecting signaling changes in amolecule that is regulated by the activator domain of the fusionprotein. For the activator domain in this fusion protein NRG1, activityis assessed by detection of increased phosphorylated ErbB-3 in cells ofhearts treated with the bi-specific fusion compared to untreated or mocktreated hearts. Myocardial infarction is generated in C57BL/6 mice byligation of the left coronary artery (LCA) following endotrachealintubation, ventilation and thoracotomy. Coronary occlusion is confirmedby acute inspection of color change of the left ventricle wall, and STelevation on the electrocardiogram before chest closure. Sham-operatedmice undergo the same surgical procedure without LCA ligation.

Hearts from normal mice or those following induction of myocardialinfarction, from both control and bi-specific fusion protein treatedmice, are removed, fixed in 4% paraformaldehyde, embedded, sectioned andmounted as described in Dhein, Mohr and Delmar, Practical Methods inCardiovascular Research, 2005, p. 473 (Springer, New York).Phospho-ErbB3 antibody (Cell Signaling Technology; Beverly, Mass.) isused for detection of Phospho-ErbB3 by immunofluorescence. A 2-foldincrease or more in phospho-ErbB3 levels in treated versus untreatedhearts is observed and is indicative of functional activator. Theincrease is in either the number (number per field, or percentage oftotal) of cells exhibiting signal, the intensity of signal per cell, orboth.

Example 4. Tissue Damage Repair in Mice Using a Bi-Specific FusionProtein

A composition comprising the representative bi-specific fusion proteinof Example 1 is administered to a mouse following myocardial infarction,induced as described above. Administration is via intravenous injection(e.g., tail vein). Following administration, heart function is assessedas follows. Mice are anesthetized with chloral hydrate (400 mg/kg bodyweight, i.p.), and the right carotid artery is cannulated with amicrotip pressure transducer (model SPR-671, Millar) for themeasurements of left ventricular (LV) pressures and LV+ and −dP/dt inthe closed-chest preparation. Measurements are compared to thoseobtained from untreated control mice to confirm that treatment with thebi-specific fusion protein affects heart function. A significantimprovement is observed in heart function as assessed using at least oneof these measurements.

Example 5. Expression and Purification of Fusion Proteins

Fusion proteins that comprise a targeting domain, a half-life modulator,and an activator domain were designed, expressed, and purified. Variouscombinations of targeting domains and activator domains were assembledwith the mHSA (SEQ ID 10) half-life modulator in different orientations,with different short connecting polypeptide sequences, and withdifferent polypeptide leader sequences. Synthetic DNA sequences weredesigned for each amino-acid sequence, taking into account the codonusage of the intended expression organism (e.g., CHO or Pichiapastoris), the desire to include or avoid particular restriction enzymerecognition sites, and other factors for codon optimization known in theart. DNA sequences were constructed and/or assembled into expressionplasmids, the plasmids were transformed into an expression organism, andfusion proteins were overexpressed. Each fusion protein was thenpurified using a combination of different methods, including CibacronBlue Sepharose chromatography, Ni affinity chromatography, anionexchange chromatography, and size exclusion chromatography.

DNA encoding complete fusion proteins or parts to be incorporated intofusion proteins (e.g. individual targeting domains, half-life modulationdomains, or activator domains) was purchased from commercial sources(BioBasic, DNA 2.0). Amino acid sequences were explicitly defined.Constraints such as codon usage and restriction sites (demanded orprohibited) were conveyed to the vendor. The final DNA sequence encodingthe protein of interest was selected from the theoretical pool ofiso-coding sequences by the vendor in accordance with those constraints,general strategies to avoid low expression (such as avoidance of highsecondary structure at the mRNA level), and vendor preferences. In somecases codon usage was tailored to CHO or Pichia alone. In other cases acombined codon usage table that avoids rare codons in distribution ofeither organism was applied. In some cases full-length fusion proteinswere supplied by the vendor in an expression vector. In other cases,subcloning to an expression vector of interest was required. Subcloningmanipulations were accomplished using traditional methods employing typeII restriction enzymes and DNA ligase (New England Biolabs). Additionalmolecular cloning to produce fusions proteins with alternativecombinations and orientations of targeting, activator, and half-lifemodulation domains was performed using these techniques as well aspolymerase chain reaction (PCR). Fusion proteins were designed with oneor more type-II restriction sites located at the junctions betweenfunctional domains at the DNA level for the facile replacement orrearrangement of any of the functional domains. When needed, restrictionsites or linker regions were added to sequences by incorporating them inthe primers used for PCR.

In some cases, proteins were expressed in Pichia pastoris using thePichiaPink Expression System (Invitrogen A11151 kit). Genes encoding theprotein of interest were cloned in frame with the Saccharomycescerevisiae α-mating factor secretion signal using the pPinka-HC plasmidto allow for secreted expression of recombinant protein. In other cases,proteins were purified using the Selexis/CHO clonal system. Genesencoding the protein of interest were cloned into Selexis vectors andtransfected into polyclonal CHO-K1 cells to allow for expression ofrecombinant protein. The pPinka-HC plasmid contains a bacterial originof replication (pUC) and resistance maker (Ampicillin) for propagationand selection of the circular plasmid in E. coli. It also contains theTRP2 gene, used for targeting the integration of the linearized vectorduring transformation into Pichia, and the ADE2 gene, included forcomplementation of adenine auxotrophy in Pichia. The AOX1 promoterensures high levels of transcription upon methanol induction and theCYC1 sequence ensured efficient transcriptional termination. Integrationof the plasmid into ADE2-deficient Pichia enabled both viability-drivenselection on adenine deficient media as well as screening based oncolony color. High copy integrants appeared white, whereas low copyintegrants appeared pink or red due to the accumulation of purineprecursors in the Pichia vacuole. White colonies were selected forprotein production and in some cases several colonies were screened forefficiency of protein production on a small scale (milliliters) beforeproduction on a large scale (liters). pPinka-HC plasmid map and detailsare available from Invitrogen.

In other cases, proteins were purified using the Selexis/CHO clonalsystem. An exemplary expression vector is pMP 20K (SELEXIS) and anexemplary cell line is CHO-k1-S (SELEXIS). pMP20K employs commonly usedgenetic elements. Expression is driven by the human GAPD promoter.Genetic elements referred to as Matrix Attachment Regions or MARelements control the dynamic organization of chromatin, and insulatenearby genes from the effect of surrounding chromatin thereby increasingcopy number dependent, position-independent, expression of genes. MARelements have been shown to improve the probability of isolating a cloneexhibiting the desired level of expression for the production of arecombinant protein and to increase the stability of production. Inaddition to the expression plasmid, antibiotic resistance plasmids (suchas pSV2-neo, SELEXIS) were also used to select for stable transformants.Expression plasmids were linearized (e.g., with Pvul) followed byQIAQUICK purification (QIAGEN). Lipofectamine LTX (Invitrogen) was usedfor transfection into CHO cells in OptiMeml (Gibco). Transfected cellswere recovered with F12Hams medium containing 10% FBS for 2 days withoutselection pressure, then with selection pressure for 4 days, then changeto serum-free medium with selection pressure. HyClone® (ThermoScientific) is used for the HSA-fused BBAs, with HT supplements (GIBCO).

Following expression, proteins were purified by a combination ofCibacron Blue Sepharose chromatography, Ni affinity chromatography,anion exchange chromatography, and size exclusion chromatography inaccordance with manufacturer instructions (GE Healthcare). Proteinproduction was monitored by sodium dodecyl sulfate polyacrylamide gelelectrophoresis (SDS-PAGE).

Protein Expression in Pichia pastoris and Subsequent Purification byChromatography.

Genes encoding the protein of interest were cloned in frame with theSaccharomyces cerevisiae α-mating factor secretion signal (SEQ ID 244,245) using the pPinka-HC plasmid (included in Invitrogen A11151 kit) toallow for secreted expression of recombinant protein. In addition, DNAencoding for a His6-tag was added to the 3′ end of the gene to allow forthe option of purification of the recombinant protein by Ni affinitychromatography. Briefly, plasmids were transformed into chemicallycompetent PichiaPink Strain 2 (Invitrogen, catalog # A11154), andcultures were grown at 30° C. in a shaking incubator in BMGY (buffercomplexed glycerol medium=1% yeast extract, 2% peptone, 100 mM potassiumphosphate, pH 6.0, 1.34% Yeast Nitrogen Base with Ammonium Sulfate,without amino acids, 0.0004% biotin, 1% glycerol) to an OD600=2-6. Atthis time, the cells were pelleted, protein expression was induced byreplacement of the media with BMMY (buffer complexed methanol medium=1%yeast extract, 2% peptone, 100 mM potassium phosphate, pH 6.0, 1.34%Yeast Nitrogen Base with Ammonium Sulfate, without amino acids, 0.0004%biotin, 0.5-1% methanol) at ⅕ the volume of the original cultures.Cultures were then grown at 20-30° C. in a shaking incubator for anadditional 24-48 hours. Every 12-24 hours, additional methanol (to afinal concentration of 0.5-1% (v/v)) was added to the cultures. At thetime of harvest, cells were pelleted by centrifugation, the supernatantwas collected, sterile filtered and stored at 4° C. until purification(typically within 3 days of harvest).

The following fusion proteins were purified according the methodsdescribed below IGF1_mHSA_AnxV (SEQ ID 136, 137); IGF1_mHSA_AnxVm1234(SEQ ID 138, 139); NRG1b(EGF)_mHSA_AnxV (SEQ ID 142, 143);NRG1b(EGF)_mHSA_AnxVm1234 (SEQ ID 254, 255); FGF2_mHSA_AnxV (SEQ ID 144,145). Recombinant proteins were purified by Ni affinity chromatographyusing Ni Sepharose 6 Fast Flow resin (GE Healthcare 17-5318-04; 1 mL ofresin/50 mL of supernatant) by gravity flow according to themanufacturer's instructions. The flow-throughs from these purificationswere then buffer-exchanged into 50 mM NaCl, 20 mM Tris, pH 7.0, usingcentrifugal concentrators, and loaded onto HiTrap Blue HP 1 mLcartridges (GE Healthcare, 17-0412-01) equilibrated in the same buffer.The proteins were purified according to the manufacturer's instructionsusing 20 mM Tris, pH 7.0, 50 mM NaCl, 30 mM sodium octanoate as theelution buffer. The eluates from Ni affinity chromatography and BlueSepharose chromatography were combined and concentrated/buffer-exchangedinto PBS (100 mM sodium phosphate, 150 mM NaCl), pH 7.2, usingcentrifugal concentrators. The samples were then loaded onto a HiPrep26/60 Sephacryl S-200 High resolution column (GE Healthcare 17-1195-01),and the proteins were eluted in PBS (100 mM sodium phosphate, 150 mMNaCl), pH 7.2, at a flow rate of 1.3 mL/min. Fractions containing theprotein of interested, as identified by (SDS-PAGE), were pooled andconcentrated using centrifugal concentrators.

Final purity was assessed by SDS-PAGE. FIG. 1 shows a SDS-PAGE ofIGF1_mHSA_AnxV (136), IGF1_mHSA_AnxVm1234 (138), NRG1b(EGF)_mHSA_AnxV(142), and NRG1b(EGF)_mHSA_AnxVm1234. Lane 1 corresponds to the proteinmolecular weight standards. Lanes 2, 4, 6, correspond to the proteinsamples under non-reducing conditions. Lanes 3, 5, 7, 9 correspond toprotein samples under reducing conditions (50 mM dithiothreitol (DTT)).As shown in FIG. 1 showed, the fusion protein (SEQ ID NO 136) run at thecorrect molecular weight (MW) on SDS-PAGE gel (expected MW=111 kDa). Thepurity is >80%. In the absence of DTT, some dimer (<10% of totalprotein) were present, and the protein ran as a double band. Truncationcould be the cause of the double band pattern observed. As shown in FIG.1, the following proteins IGF1_mHSA_AnxVm1234 (SEQ ID NO 138),NRG1b(EGF)_mHSA_AnxV (SEQ ID NO 142), NRG1b(EGF)_mHSA_AnxVm1234 (SEQ IDNO 254) ran at the correct molecular weight (MW) on SDS-PAGE gel(expected MW=111 kDa). The purity of these fusion proteins was superiorto 80%. In the absence of DTT, some dimer form of the proteins werepresent (<10% of total protein) and the dimers were eliminated with theaddition of DTT.

After purification, the purity of FGF2_mHSA_AnxV fusion protein (SEQ IDNO 144) was about 50%. The fusion protein ran as a double band, one ofwhich is at the correct MW (120 kDa), and one of which is at a lower MW.This result may suggest that the lower molecular weight band is atruncation product.

The recombinant fusion protein AnxV_mHSA_FGF2 (SEQ ID NO 118) waspurified by Ni affinity chromatography using Ni Sepharose 6 Fast Flowresin (GE Healthcare 17-5318-04; 1 mL of resin/50 mL of supernatant) bygravity flow according to the manufacturer's instructions. TheBinding/Wash Buffer consisted of 20 mM potassium phosphate, pH 7.4, 500mM NaCl, 25 mM imidazole, and the Elution Buffer consisted of 20 mMpotassium phosphate, pH 7.4, 500 mM NaCl, 450 mM imidazole. Followingpurification, purity was assessed by SDS-PAGE. The fusion protein ran atthe correct MW on the gel (120 kDa) and showed a purity superior to 80%.

AnxV_mHSA_NRG1b(EGF) (SEQ ID 120, 121), AnxVm1234_mHSA_NRG1b(EGF) (SEQID 116, 117), AnxV_mHSA_IGF1 (SEQ ID 134, 135), AnxVm1234_mHSA_IGF1 (SEQID 114, 115), AnxVm1234_mHSA_FGF2 (SEQ ID 264, 265), IGF1_mHSA_B7scFv(SEQ ID 150, 151), aDNASI1_mHSA_FGF2 (SEQ ID 124, 125),aDNASI1_mHSA_NRG1b(EGF) (SEQ ID 126, 127), IGF1_mHSA_Syt1 (SEQ ID 152,153), Syt1_mHSA_IGF1 (SEQ ID 170, 171), IGF1_mHSA_aDNASI1 (SEQ ID 154,155), NRG1b(EGF)_mHSA_B7scFv (SEQ ID 156, 157) were purified accordingthe methods described below. Blue Sepharose 6 Fast Flow resin (GEHealthcare 17-0948-03) was packed into Econo-pac (Bio-Rad 732-1010)columns (1.5 cm inner diameter; 4 mL resin/column) using standardprocedures. Chromatography was performed using an 8-channel peristalticpump. The columns were equilibrated with buffer containing 50 mM NaCl,20 mM Tris, pH 7.0 (Blue Sepharose Wash Buffer). The conductivity of theprotein expression supernatants was adjusted with deionized water tomatch that of the Blue Sepharose Wash Buffer (as determined using aconductivity meter). The supernatants from each protein expressionculture were loaded onto the columns at 4-5 mL/min. Columns were washedwith 5-10 column volumes of Blue Sepharose Wash Buffer. Protein was theneluted with 5-10 column volumes of Low Salt (LS) Elution Buffer (20 mMTris, pH 7.1, 50 mM NaCl, 45 mM Na-Octanoate). In some cases (proteinshaving SEQ IN Nos 120, 116, 134, 114, 264), this elution step wasdivided into 5×1.5 mL fractions (A1-5) followed by 7×4 mL fractions(B1-7). Following elution with Low Salt Elution Buffer additionalprotein was eluted with 5 column volumes of High Salt (HS) ElutionBuffer (20 mM Tris, pH 7.1, 1 M NaCl, 45 mM Na-Octanoate). Fractionswere analyzed for protein content by SDS-PAGE concentrated bycentrifugal ultrafiltration (Sartorius-Stedim, VS2022), and desaltedinto 0.1M sodium phosphate, 0.15M NaCl, pH 7.2 using PD-10 columns (GE17-0851-01). Fractions containing the protein of interest were pooled.Fractions of the AnxV_mHSA_NRG1b(EGF) (SEQ ID 120) fusion protein wasanalyzed by SDS-PAGE. The purified fusion protein was about 50% pure.Analysis of the SDS-PAGE showed a double band on the gel. One of theband was at the expected MW (112 kDa) of the full length fusion protein,and one of the band was characterized by a lower MW which may suggest itwas a truncation product. Fractions of the AnxVm1234_mHSA_NRG1b(EGF)(SEQ ID 116) fusion protein was analyzed by SDS-PAGE. SDS-PAGE analysisshowed a purity of about 50% and a double band on the gel. One of theband was at the correct MW (112 kDa) of the full length fusion protein,and one of the band was characterized by a lower MW which may suggest itwas a truncation product. Fractions of the AnxV_mHSA_IGF1 (SEQ ID 134)fusion protein was analyzed by SDS-PAGE. SDS-PAGE analysis showed apurity of about 50% and a double band on the gel. One of the band was atthe correct MW (111 kDa) of the full length fusion protein, and one ofthe band was characterized by a lower MW which may suggest it was atruncation product. Fractions of the AnxVm1234_mHSA_IGF1 (SEQ ID 114)fusion protein was analyzed by SDS-PAGE. SDS-PAGE analysis showed apurity of about 50% and a double band on the gel. One of the band was atthe correct MW (111 kDa) of the full length fusion protein, and one ofthe band was characterized by a lower MW which may suggest it was atruncation product. Fractions of the AnxVm1234_mHSA_FGF2 (SEQ ID 264)fusion protein was analyzed by SDS-PAGE. SDS-PAGE analysis showed apurity of about 50% and a double band on the gel. One of the band was atthe correct MW (120 kDa) of the full length fusion protein, and one ofthe band was characterized by a lower MW which may suggest it was atruncation product. Fractions of the IGF1_mHSA_B7scFv (SEQ ID 150)fusion protein was analyzed by SDS-PAGE. SDS-PAGE analysis showed apurity of more than 50% and a double band on the gel. One of the bandwas at the correct MW (102 kDa) of the full length fusion protein, andone of the band was characterized by a lower MW which may suggest it wasa truncation product. Fusion protein aDNASI1_mHSA_FGF2 (SEQ ID NO 124)was analyzed on SDS-PAGE and showed a purity of less than 20% with aband corresponding to the correct MW (110 kDa) of the full-lengthprotein. The presence of lower MW bands suggested that the protein maybe cleaved or truncated. Fusion protein aDNASI1_mHSA_NRG1b(EGF) (SEQ IDNO 126) was analyzed on SDS-PAGE and showed a purity of less than 50%with a band corresponding to the correct MW (110 kDa) of the full lengthprotein. The presence of lower MW bands suggested that the protein maybe cleaved or truncated. Fusion protein IGF1_mHSA_Syt1 (SEQ ID NO 152)was analyzed on SDS-PAGE and showed a purity of about 50% with a bandcorresponding to the correct MW (91 kDa) of the full-length protein. Thepresence of lower MW bands suggested that the protein may be cleaved ortruncated. Fusion protein Syt1_mHSA_IGF1 (SEQ ID NO 170) was analyzed onSDS-PAGE and showed a purity of less than 50% with a band correspondingto the correct MW (91 kDa) of the full-length protein. The presence ofhigher and lower MW bands suggested the presence of dimeric products andtruncation products. Fusion protein IGF1_mHSA_aDNASI1 (SEQ ID NO 154)was analyzed on SDS-PAGE and showed a purity of about 50% with a bandcorresponding to the correct MW (102 kDa) of the full-length protein.Fusion protein NRG1b(EGF)_mHSA_B7scFv (SEQ ID NO 156) was analyzed onSDS-PAGE and showed a purity of less than 50% with a band correspondingto the correct MW (102 kDa) of the full length protein and a lower MWband which may correspond to a truncation product.

AnxV_mHSA (SEQ ID 252, 253) and AnxVm1234_mHSA (SEQ ID 250, 251) fusionproteins were purified according the methods described below. Proteinswere precipitated from Pichia expression supernatant by Ammonium Sulfate(added to a final concentration of 82%). Precipitate was resuspended inPBS buffer and dialyzed against PBS overnight. Following dialysis,protein was loaded onto a HiPrep 26/60 Sephacryl S-200 High resolutioncolumn (GE Healthcare 17-1195-01) equilibrated in 50 mM NaCl, 20 mMpotassium phosphate, pH 7.0. Protein was eluted in the same buffer,fractions from the elution were analyzed by SDS-PAGE, and fractionscontaining the protein of interest were pooled. This pooled eluate wasthen loaded (at a flow rate of 1 mL/min) onto a 1 mL HiTrap Q SepharoseFast Flow column (GE Healthcare 17-5053-01) equilibrated in 20 mMpotassium phosphate, 50 mM NaCl, pH 7.0. Protein was eluted with ElutionBuffer (20 mM potassium phosphate, 500 mM NaCl, pH 7.0) over a gradientof 20 column volumes at 1 mL/min. Fractions were collected and analyzedby SDS-PAGE. Fractions containing protein of interest were pooled. Finalpurity was assessed by SDS-PAGE in the presence and absence ofreductant. Fusion protein AnxV_mHSA (SEQ ID NO 252) was analyzed onSDS-PAGE and showed a purity of more than 90% with a band correspondingto the expected MW (104 kDa) of the full-length protein. Some dimers(<10% of the total protein) were present but were eliminated in thepresence of DTT. Fusion protein AnxVm1234_mHSA (SEQ ID NO 252) wasanalyzed on SDS-PAGE and showed a purity of more than 90% with a bandcorresponding to the expected MW (104 kDa) of the full-length protein.Some dimers (<10% of the total protein) were present but were eliminatedin the presence of DTT.

Protein Expression in Selexis/CHO Expression System and SubsequentPurification by Chromatography.

A stable Selexis CHO cell line expressing the protein of interest wascultured in serum-free media at 37° C., 5-8% CO2 in a shaking incubator.Media used for growth was: 1 L Ex-Cell™ CD CHO Fusion media (Sigma,14365C-1000 ML), 40 mL of 200 mM L-glutamine (Invitrogen, 25030-081), 10mL 100× HT supplement (Invitrogen, 11067-030). The seeding density forthe cells was 0.3-0.5×106 cells/mL. The culture was diluted once itreached 2-4×106 cells/mL, until the desired culture volume (6 L) wasachieved. Cell Boost solution (1 L ddH2O, 35 g Cell Boost 5 (HyClone,30865.01), 20 g D-glucose, adjust pH to 7.0 with NaOH) was added 3-5days after seeding the final large culture (amount of Cell Boost=7-12%of the culture). Cell supernatant containing secreted protein ofinterest was harvested as soon as the culture viability dropped below90% (˜1 week after diluting the culture to its final volume). The cellsupernatant was harvested by centrifugation and was sterile filtered.Supernatant was stored at 4° C. if purification was to be performedwithin a week, otherwise the supernatant was stored at −80° C.

Fusion proteins aDNASI1(L23)_mHSA_HGF(NK1) (SEQ ID 110, 111),DAscFv_mHSA_IGF1 (SEQ ID 246, 247), DAscFv_mHSA_HGF(NK1) (SEQ ID 248,249) were purified according to the methods described below. Supernatantfrom Selexis/CHO expression was diluted 1:0.5 with ddH2O and passed overa 5 mL Blue Sepharose column twice. Protein was eluted in buffercontaining 45 mM Na Octanoate then dialyzed against PBS. Protein wasthen diluted 1:1 with ddH2O and loaded onto a 1 mL Q anion exchangecolumn and eluted with shallow gradient (gradient=10% B, where A=1:1PBS:water, B=1 M NaCl in PBS, PBS=standard Dulbecco's PBS, Mg/Ca free).Fractions containing protein of interest were pooled and frozen inaliquots. Final purity was assessed by SDS-PAGE. All purified proteinsshowed a purity superior to 90% and ran as a single band on SDS-PAGE. ASDS PAGE of the aDNASI1(L23)_mHSA_HGF(NK1) (SEQ ID 110) fusion proteinshowed a single band at the expected MW of 114 kDa. A SDS_PAGE of theDAscFv_mHSA_IGF1 (SEQ ID 246) fusion protein showed a single band at theexpected MW of 102 kDa. A SDS PAGE of the DAscFv_mHSA_HGF(NK1) (SEQ ID248) fusion protein showed a single band at the expected MW of 115 kDa.

Example 6. Specific Binding of Bi-Specific Fusion Protein to DamagedCells

Fusion proteins that comprise a targeting domain, a half-life modulator,and an activator domain were produced, and their ability to specificallybind via their targeting domain to damaged cells in vitro was validated.The targeting domain used was human annexin V (AnxV, SEQ ID 31), whichbinds to phosphatidylserine which becomes exposed on the outer cellsurface during apoptosis. Specific binding was demonstrated for avariety of fusion proteins, including fusion proteins with differentactivator domains, and fusion proteins in different fusion orientations(e.g., N-terminal activator domain with C-terminal targeting domain, andN-terminal targeting domain with C-terminal activator domain). Specificbinding was also demonstrated for binding to damaged cells of differentcell types, including cardiac muscle cells and embryonic stemcell-derived (ESC-derived) cardiac cells. In some cases, cells wereinjured with hydrogen peroxide (H₂O₂) to induce oxidative stress tomimic the damaged state of cells in vivo after myocardial infarction.Fusion proteins comprising a non-binding variant of annexin V(AnxVm1234, SEQ ID 84), did not bind to damaged cells, demonstratingthat binding of fusion proteins was modulated by the annexin V targetingdomain. Overall, these data demonstrate the capability of fusionproteins to deliver an activator domain specifically to damaged cellsvia the specific binding of a fused targeting domain.

Binding of fusion proteins to cells was observed using flow cytometry.Apoptotic cell death was induced by oxidative stress from treatment withhydrogen peroxide (H₂O₂). Apoptotic or dead cells were identified bylabeling with propidium iodide (PI) or by labeling with a fluorescentAnnexin V-based commercial apoptosis detection kit. In some cases,fusion proteins were first covalently labeled with a fluorescent dye forlater detection. In these cases, specific binding of fusion protein toapoptotic cells was demonstrated by observing cells to bedouble-positive for both PI and the fusion-protein fluorescence, whileequivalent cells incubated with a non-binding variant of the fusionprotein were PI positive but negative for fusion-protein fluorescence.In other cases, the fusion proteins were not first covalently labeled,and instead a fluorescently-labeled secondary antibody that binds to thehalf-life modulator in the protein fusion was used for detecting thefusion protein. In these cases, specific binding of fusion protein toapoptotic cells was demonstrated by showing a strong correlation betweenthe amount of fluorescent signal from the fusion protein secondaryantibody to the amount of fluorescent signal from the commercial annexinV-based detection kit.

A. Specific Binding of IGF1_mHSA_AnxV to Apoptotic Heart Cells

The fusion proteins IGF1_mHSA_AnxV (SEQ ID 136) and IGF1_mHSA_AnxVm1234(SEQ ID 138) were expressed and purified as described in Example 5. Bothproteins were covalently labeled with Alexa Fluor 488 (Alexa Fluor 488microscale protein labeling kit, Invitrogen, A30006) following themanufacturer's instructions. HL-1 cells (William C. Claycomb, LouisianaState University Health Sciences Center), a cardiac muscle cell linewith characteristics of adult cardiomyocytes, were seeded ingelatin/fibronectin pre-coated 96-well plates (BD/Falcon, 353072) at 1:3in complete medium (Claycomb medium (Sigma, 51800C), containing 10% FBS(Sigma, 12103C), 2 mM L-glutamine (Invitrogen/Gibco, 25030), 100 U/mLpenicillin+100 ug/mL streptomycin (Invitrogen/Gibco, 15070), and 0.1 mMnorepinephrine (Sigma, A0937)) and incubated at 37° C. and 5% CO2. Twodays later, the cells were re-fed with 0.1 mL/well of mediumsupplemented with 400 uM H2O2 (Sigma, H1009), and incubated for 15 minat 37° C. and 5% CO2. Next, the H2O2-supplemented medium was aspiratedfrom each well and replaced with complete medium and the cells wereincubated for 20-24 hr at 37° C. and 5% CO2. The next day, medium fromeach well was transferred into a 96-deepwell v-bottom plate (USAScientific, 1896-1110) to collect detached cells. The cells were washedonce with PBS (Sigma, D8537) and then trypsinized using 40 uL of 0.025%Trypsin-EDTA and placed in a 37° C. incubator. Cell detachment wasmonitored under a microscope and 100 uL/well of DMEM plus 10% FBS wasadded to deactivate the trypsin. Cells were washed with cold PBS andresuspended in 100 uL of binding buffer (component of Annexin V-FITCapoptosis detection kit, BD Biosciences, 556547). Alexa Fluor488-labeled fusion protein was then added and incubated in the dark onice for 1 hr. Positive-control detection of apoptotic cells was obtainedusing an Annexin V-FITC apoptosis detection kit (BD Biosciences,556547). In both cases, 3 uL of propidium iodide (PI) was added for thefinal 15 min of incubation. Cells were analyzed on a BD FACSCanto IIflow cytometer, using appropriate unstained and single-stained controlsfor calibration.

Apoptotic cells were co-labeled with Annexin V-FITC and propidium iodide(PI) from the BD Biosciences apoptosis detection kit (FIGS. 2A-2D and3A-3B). 56% of cells were in the double-positive quadrant, indicatinglate apoptosis or cell death. Positive and negative populations werefairly well separated.

IGF1_mHSA_AnxV (SEQ ID 136) and IGF1_mHSA_AnxVm1234 (SEQ ID 138) wereeach labeled with Alexa Fluor 488, achieving a degree-of-labeling (DOL)of 7.1 and 8.1 mole dye/mole protein, respectively. Apoptotic cells werealso co-labeled with 80 ng (7.1 nM) of IGF1_mHSA_AnxV and PI (FIGS.4A-4C and 5A-5B), or 80 ng (7.1 nM) of IGF1_mHSA_AnxVm1234 and PI (FIGS.6A-6C and 7A-7B). The IGF1_mHSA_AnxV-labeled cells displayed a fairlywell-separated double-positive peak (53% of cells), very similar to theapoptosis detection-kit positive control, indicating that the fusionprotein bound specifically to apoptotic or dead cells. On the otherhand, the IGF1_mHSA_AnxVm1234-labeled cells did not display adouble-positive peak (0% of cells), indicating that the non-bindingtargeting arm did not bind to apoptotic or dead cells, as designed.Together, these data showed that a fusion protein comprising annexin V(AnxV) as a targeting domain can bind specifically to apoptotic or deadcardiac cells, and may therefore be used to deliver a fused agent ormolecule having a biological (e.g. therapeutic) effect, such as anactivator domain, to treat injured or damaged cardiac tissue.

B. Specific Binding of IGF1_mHSA_AnxV to Apoptotic Heart Cells

To verify that the binding to apoptotic heart cells observed in Example6A was specific to the AnxV targeting domain in the IGF1_mHSA_AnxVfusion protein, and not a result of binding from the IGF1 domain tocell-surface IGF receptors, the experiment was repeated with theinclusion of an IGF1 pre-incubation step to saturate and block any/allIGF1 cell surface receptors. The methods used were the same as inExample 6A, except that the H2O2 concentration was changed to 200 μM. Inaddition, after resuspension of the cells in binding buffer, but priorto addition of Alexa Fluor 488-labeled fusion protein, 800 nM of IGF1(Calbiochem, 407240) was added and incubated for 10 min to pre-blockany/all IGF1 cell surface receptors with IGF1.

The Annexin V-FITC plus PI positive control in FIGS. 8A-8C and 9A-9Bshowed that approximately 40% were double-positive, indicating lateapoptosis or cell death population. FIGS. 10A-10C and 11A-11Bdemonstrated binding of IGF1_mHSA_AnxV to apoptotic cells, while thenon-binding control fusion, IGF1_mHSA_AnxVm1234, did not bind (FIGS.12A-12C and 13A-13B), as shown in Example 6A. Next, to demonstrate thatIGF1_mHSA_AnxV did not appreciably bind to cells via its IGF1 domain,the assays were repeated with the IGF1 blocking step. FIGS. 14A-14C and15A-15B showed the binding of IGF1_mHSA_AnxV to apoptotic cells, even inthe presence of, and after incubation with, excess IGF1. These datademonstrated that the AnxV targeting domain was responsible for thespecific binding of protein fusions to apoptotic cells.

C. Specific Binding of AnxV_mHSA to Apoptotic ESC-Derived Cardiac Cells

AnxV_mHSA (SEQ ID 252) and AnxVm1234_mHSA (SEQ ID 250) were directlyconjugated to Alex Fluor 647 (Alexa Fluor 647 carboxylic acid,succinimidyl ester, Invitrogen, A-20006) following the manufacturer'sinstructions. Embryonic stem cell-derived (ESC-derived) cardiac cells(Peter Zandstra, University of Toronto) were derived essentially asdescribed in Yang et al (Nature 2008, 453:524-8). Protocol was derivedfrom Bauwens C L, et al. Tissue Eng Part A. 2011 Apr. 25., GeometricControl of Cardiomyogenic Induction in Human Pluripotent Stem Cells.”Aggregate-based differentiation of hESCs was carried out using aprotocol for serum-free directed differentiation to the cardiac lineagewhich has been previously described. HESC aggregate size was controlledby forced aggregation of defined cell concentrations in AggreWell™inserts (STEMCELL Technologies) containing a textured surface ofmicro-wells. Briefly, a single cell suspension of feeder depleted hESCswas spun down into Aggrewells at a density of 1000 cells/micro-well.Cells were allowed to aggregate in hypoxic conditions over night inStemPro34 supplemented with Glutamax, ascorbic acid, transferrin,pen/strep as base media, with the addition of ROCK inhibitor and 0.5ng/ml BMP4. On day 1 the media was replaced by base media with 10 ng/mlBMP4, 3 ng/ml Actvin A and 5 ng/ml bFGF. On day 4, cells were removedfrom the micro-wells, washed with DMEM F12 supplemented with 5% KOSR andtransferred to low cluster plates in base media with 10 ng/ml VEGF and150 ng/ml Dkk1. On day 8 the media was replaced by base media with 10ng/ml VEGF, 150 ng/ml Dkk1 and 5 ng/ml bFGF. On day 12 the media wasreplaced again (same cytokines) and cells were transferred to normoxicconditions until day 16.

Even without H2O2 or doxorubicin treatment, the cardiac cells exhibit ameasureable apoptotic population, based on PI labeling and the AnnexinV-FITC detection kit (FIG. 16). Further addition of doxorubicin did notincrease the apoptotic fraction. Nevertheless, apoptotic cell populationwas sufficient for testing the binding of apoptosis-targeting fusionproteins. The cardiac cell population was incubated with eitherAnxV_mHSA or AnxVm1234_mHSA, while being co-incubated with the AnnexinV-FITC detection kit as well. The fluorescent signal from the AlexaFluor 647 on the AnxV_mHSA fusion, and not from the AnxVm1234_mHSAfusion, correlated strongly with the FITC signal from the apoptosisdetection kit (FIGS. 17A-17B), demonstrating that AnxV_mHSA bindsspecifically to apoptotic ESC-derived cardiac cells.

D. Specific Binding of AnxV_mHSA_NRG1b(EGF) to Apoptotic ESC-DerivedCardiac Cells

Binding of the fusion protein AnxV_mHSA_NRG1b (SEQ ID 120) to apoptoticESC-derived cardiac cells was demonstrated using a secondary detectionscheme, instead of first altering the fusion protein with a covalentlyattached fluorophore. The fusion protein was detected using an anti-HSAantibody (goat anti-human albumin antibody affinity purified, BethylLabs, A80-129A) that was itself covalently labeled with Alexa Fluor 647(Alexa Fluor 647 carboxylic acid, succinimidyl ester, Invitrogen,A-20006) following the manufacturer's instructions. Cardiac cells wereincubated with AnxV_mHSA_NRG1b(EGF), while being co-incubated with theAnnexin V-FITC detection kit as described in Example 6C. The fusionprotein was detected by the anti-HSA Alexa Fluor 647 secondary antibody.Fluorescent signal from the Alexa Fluor 647 correlated strongly with theFITC signal from the detection kit (FIGS. 18A-18B). This demonstratedthat AnxV_mHSA_NRG1b(EGF) binds to apoptotic ESC-derived cardiac cells.Furthermore, a control experiment that excluded fusion protein (“NoLigand” in FIGS. 18A-18B), but still incubated with secondary detectionreagents, did not exhibit any correlation of Alexa Fluor 647 signal tothe apoptosis-based FITC signal, demonstrating that the original AlexaFluor 647 fluorescent signal was due to binding of the fusion proteinitself and not due binding of the secondary antibody alone.

Example 7. Specific Binding of Fusion Proteins to their Targets

The process of localizing therapeutics to a disease-related area of thepatient can be accomplished by targeting molecular epitopes that areeither restricted to, or particularly abundant in, the area of interest.For example, myocardial infarction can expose several target molecules(e.g. DNA, cardiac myosin, and phosphatidylserine) upon tissue damagethat can be exploited for this purpose. Several fusion proteins wereproduced that comprise targeting domains specific for these targetmolecules. In particular, annexin V and synaptotagmin can be used totarget phosphatidylserine, and the SI-1 single-chain variable fragment(aDNASIscFv) can be used to target DNA. However, one skilled in the artwill appreciate that the inclusion of a binding domain in a fusionprotein may result in the loss or change of properties of eachindividual domain (e.g. change in binding affinity, change in biologicalactivity). To determine if functionality can be maintained in the fusionproteins disclosed herein, an ELISA-based in vitro binding test wasdeveloped and applied. Essentially, the assay showed thattargeting-competent fusion proteins were retained in microplate wells,despite stringent washing, due to their interaction with cognate targetmolecules lining the well surfaces. The presence of fusion protein wasquantified immunochemically. In the absence of cognate target molecule,or presence of non-cognate target molecules, retention was not expected,in the absence of unexpected targeting domain cross reactivity. Thecombination of retention with cognate target molecule, and clearancewithout, was taken as proof of binding specificity and targetingfunction.

Microplates (Pierce 15041) were coated with the epitopes of interest.Phosphatidylserine (PS, Avanti Polar Lipids 840032) was deposited byevaporating to dryness 504/well of a 12.5 μg/mL solution in Methanol.DNA (Sigma D3664) was deposited by adding 504 of a pre-mixed 1:1solution of DNA at 10 μg/mL and DNA Coating Reagent (Pierce 17250) towells. Myosin was deposited by incubating a 10 μg/mL solution inDublecco's PBS. All coating reactions were performed at room temperaturefor 2 hours with 200 rpm shaking. After washing, 2504/well ofprotein-free blocking buffer (Pierce 37572) was added and platesincubated at room temperature for 3-4 hours. After further washing, 1004of chromatographically purified fusion proteins were added to wells atconcentrations ranging from 160 ng/mL-20 μg/mL. Binding proceeded fortwo hours at room temperature in 10 mM Hepes, 140 mM NaCl, 2.5 mM CaCl2,pH 7.4. After further washing, 100 uL detection antibody (Goatanti-Human Albumin Antibody HRP Conjugated, Bethyl Labs A80-129P) wasadded to wells at dilutions of either 1:5,000 or 1:50,000 in PBST andincubated for 30-60 minutes. After further washing, 754 peroxidasesubstrate (Pierce TMB Ultra 34028) was applied, and upon the observationof significant color development, the reaction quenched with 754 of Stopsolution (KPL 50-85-05). Absorbance of wells was read at 450 nm in aplate reader (Tecan M200 Pro). All fusion proteins and antibodycombinations were performed in triplicate. All wash steps consisted offour cycles of dispensing and aspirating 2504 PBST with five second soakand shake steps between cycles using an automated 96 well plate washer(Biotek, Elx405). Mock coated blank wells (solvent, coating reagent, orbuffer only) and wells without fusion protein were included as negativecontrols.

Fusion proteins were produced as detailed in Example 5. IGF1_mHSA_Syt1(SEQ ID 152) and IGF1_mHSA_AnxV (SEQ ID 136) were shown to specificallybind phosphatidylserine (FIGS. 19A-19B). aDNASI1_mHSA_FGF2 (SEQ ID 124),aDNASI1_mHSA_NRG1b(EGF) (SEQ ID 126), and IGF1_mHSA_aDNASI1 (SEQ ID 154)were shown to bind specifically to DNA (FIGS. 20A-20C).

The fusion proteins were shown to bind specifically to the targetmolecules demonstrating the retention of functional binding after fusinga targeting domain to a half-life modulator and activator domain andalso exemplifying the breadth of targeting domains (as well as target)capable of being fused into fusion proteins. Specific targets, such asphosphatidylserine, may be addressed with a variety of binding domains,such as annexin V and synaptotagmin. Conversely, specific proteinclasses, like the antibody-derived scFvs, of which aDNASI1 is a member,have a large diversity of members which bind a correspondingly largevariety of target molecules or epitopes. The successful incorporation ofscFvs into fusion proteins is an indication of the potential for theapplication of antibody-derived targeting in other fusion proteins. TheaDNASI1 domain was further shown to be functional in either N- orC-terminal fusion orientation as well as in fusions that contain avariety of activator domains. Taken together, these results establishthat fusion proteins targeting may not be restricted to a specifictarget epitope, a specific class of targeting domain, a specifictranslational orientation, or a specific activator domain-containingmolecule.

Example 8. Modulation of Cell Activity

The bioactivity of the activator domains of purified fusion proteins wasdemonstrated in vitro by measuring downstream signaling in stimulatedcells. The potency of the fusion proteins was compared to that ofwild-type, non-fused activator domains. A variety of fusion proteinswith different activator domains, different targeting domains, anddifferent fusion orientations were produced and demonstrated to bebioactive. These data demonstrate that fusion proteins can be producedthat are bioactive and capable of signaling cellular pathways such aspro-survival or proliferative pathways.

Each fusion protein was tested alongside a positive-control,commercially obtained, non-fused version of its activator domain. Fusionproteins with active targeting domains (e.g., AnxV) as well asnon-binding control targeting domains (e.g., AnxVm1234 or DAscFv) wereboth used, demonstrating that activity of the activator domain wasindependent of the identity and function of the targeting domain. Cellsto be stimulated were grown, serum starved, and then stimulated with thefusion proteins. Proteins were then washed away, and cell activity wasmeasured by ELISA for either phospho-Akt (pAkt) or phospho-Erk (pErk).

A. Stimulation of AKT Activity in Cancer Cells Using NRG1b(EGF) FusionProteins

The fusion proteins NRG1b(EGF)_mHSA_AnxV (SEQ ID 142) andAnxV_mHSA_NRG1b(EGF) (SEQ ID 120) were produced as described in Example5. Wild-type NRG1b(EGF) was obtained from R&D Systems (396-HB/CF). DU145cells, a human prostate carcinoma, epithelial-like cell, were seeded in96-well plates (BD/Falcon, 353072) at 25,000 cells/well in completemedium (RPMI-1640 (Invitrogen/Gibco, 11875) containing 10% FBS (Hyclone,SH30071), 2 mM L-glutamine (Invitrogen/Gibco, 25030), and 50 U/mLpenicillin+50 ug/mL streptomycin (Invitrogen/Gibco, 15070)) andincubated overnight at 37° C. and 5% CO2. The next day, the media wasaspirated, the cells were washed with 0.1 mL/well PBS (without calciumand magnesium, Sigma, D8537), the cells were re-fed with 0.1 mL/well ofRPMI-1640+0.5% FBS, and the cells were incubated for 20-24 hr at 37° C.and 5% CO2. The next day, cells were stimulated with diluted fusionproteins or control proteins, adding 25 μL/well to the existing 0.1mL/well, for 10 min at 37° C. and 5% CO2. Stimulation was stopped byaspirating media from the wells and washing with 0.2 mL/well cold PBS.Cells were lysed in 25 μL/well complete M-PER lysis buffer (Mammalianprotein extraction reagent (Pierce/ThermoScientific, 78501), 150 mMNaCl, protease inhibitor cocktail (Roche complete mini, 04 693 124 001),and phosphatase inhibitors (Roche PhosSTOP, 04 906 837 001)), preparedin advance. Plates were sealed, cells were lysed on an orbital shakerfor 30 min at 4° C., and lysates were snap frozen on dry ice and storedat −78° C. 384-well flat, white plates (MaxiSorp, Nunc, 460372) werecoated with anti-Akt capture antibody (clone SKB1, Millipore, 05-591),sealed, and stored at room temp overnight.

The next day, the cell lysates were thawed and ELISA plates were washed& blocked. Thawed lysates were pooled, ELISA plates were washed again,Akt standards or pooled lysates were added to the ELISA plates, andplates were incubated for 2 hr at room temp. ELISA plates were washed,anti-phospho Akt detection antibody (biotinylated mouse mAb, CellSignaling, 5102) was added, and plates were incubated for 1.5 hr at roomtemp. The plates were washed, streptavidin-horseradish peroxidase(SA-HRP, R&D Systems, 890803) was added, and plates were incubated for30 min at room temp. Plates were washed again, substrate (SuperSignalELISA Pico Chemiluminescent, Pierce/ThermoScientific, 37069) was added,and luminescence was read on a plate reader. The pAkt standard curve wasfit to a line (log-log scale).

Activities of NRG1b(EGF) and NRG1b(EGF)_mHSA_AnxV are shown in FIG. 21.Both the commercial wild-type NRG1b(EGF) and the fusion protein wereshown to be bioactive, stimulating the pAkt pathway. Similarly, FIG. 22shows the activities of the wild type and the reverse-orientation fusionprotein, AnxV_mHSA_NRG1b(EGF). These results demonstrate thattranslationally fusing the NRG1b(EGF) activator domain to mHSA and AnxVdid not abolish its bioactivity, as the NRG1b(EGF) fusions proteinsexpressed and purified in Example 5 were bioactive.

B. Stimulation of AKT Activity in Cancer Cells Using IGF1 FusionProteins

The fusion proteins IGF1_mHSA_AnxV (SEQ ID 136), IGF1_mHSA_AnxVm1234(SEQ ID 138), and IGF1_mHSA_B7scFv (SEQ ID 150) were produced asdescribed in Example 5. Wild-type IGF1 was obtained from Calbiochem(407240). DU145 cells were grown and stimulated as described in Example8A. All three IGF1-based protein fusions were shown to be bioactive inthe DU145 cancer cells, with similar pAkt stimulation as for wild-typeIGF1 (see FIGS. 23-24).

C. Stimulation of AKT Activity in Heart Cells Using IGF1 Fusion Proteins

The fusion protein IGF1_mHSA_AnxV (SEQ ID 136) was produced as describedin Example 5. Wild-type IGF1 was obtained from Calbiochem (407240). HL-1cells (William C. Claycomb, Louisiana State University Health SciencesCenter), a cardiac muscle cell line with characteristics of adultcardiomyocytes, were seeded in gelatin/fibronectin pre-coated 96-wellplates (BD/Falcon, 353072) at 60,000 cells/well in complete medium(Claycomb medium (Sigma, 51800C), containing 10% FBS (Sigma, 12103C), 2mM L-glutamine (Invitrogen/Gibco, 25030), 100 U/mL penicillin+100 ug/mLstreptomycin (Invitrogen/Gibco, 15070), and 0.1 mM norepinephrine(Sigma, A0937)) and incubated overnight at 37° C. and 5% CO2. Cells werewashed and subjected to an ELISA protocol as described in Example 8A.

The IGF1_mHSA_AnxV fusion protein was shown to be bioactive in heartcells, and its potency comparable to wild-type IGF1 (see dose responseactivities, FIG. 25). These data demonstrate that an activator domainfused to a half-life modulator and a targeting domain can be producedand can retain its ability to potently stimulate cells.

D. FGF2 Fusion Protein Stimulates ERK Activity in Heart Cells

Cardiomyocytes derived from embryonic stem cells (ESCs, provided byPeter Zandstra's lab at the University of Toronto) were dissociated andseeded in gelatin pre-coated 96-well plates at 40,000 cells/well inStemPro-34 medium (Invitrogen/Gibco, 10639) supplemented with 38.5×StemPro-34 nutrient supplement (provided with StemPro-34 medium), 2 mML-glutamine (Invitrogen/Gibco, 25030), 50 U/mL penicillin+50 ug/mLstreptomycin (Invitrogen/Gibco, 15070), 0.4 mM monothioglycerol (Sigma,M6145), 50 ug/mL ascorbic acid (Sigma, A4544), 150 ug/mL transferrin(Sigma T8158), 10 ng/mL VEGF (R&D Systems, 293-VE), 150 ng/mL DKK-1 (R&DSystems, 5439-DK), and 5 ng/mL basic FGF (FGF2, PeproTech, 100-18b), andincubated at 37° C. and 5% CO2. Twenty-four hours prior to stimulation,the growth medium was changed to StemPro-34 without nutrient supplementand growth factors. Cells were stimulated and lysed as described inExample 8A. For the ELISA, a 96-well high binding black ELISA plate wascoated with phospho-Erk1/Erk2 capture antibody (R&D Systems, DYC1018),sealed, and stored overnight at room temperature. The next day, lysateswere subjected to the ELISA protocol described in Example 8A, exceptthat instead of Akt standards and an anti-phospho-Akt detectionantibody, phospho-Erk1/Erk2 standards (R&D Systems, DYC1018) and aphospho-Erk1/Erk2 detection antibody (R&D Systems, DYC1018) were used tomeasure activated Erk1/Erk2 levels. The fusion protein AnxV_mHSA_FGF2(SEQ ID 118) was compared to wild-type FGF2 for stimulation of pERKESC-derived cardiac cells and was shown to be bioactive (FIG. 26).

Example 9. Accumulation of Fusion Proteins Accumulate with ApoptoticCells and Stimulation of Cell Activity

The ability of fusion proteins to specifically bind to cells via theirtargeting domain and subsequently stimulate cell signaling pathways viatheir activator domain was demonstrated in vitro. The targeting domainused was human annexin V (AnxV, SEQ ID 31). AnnV can bind tophosphatidylserine which becomes exposed on the outer cell surfaceduring apoptosis. The activator domain used was IGF1 (SEQ ID 3), whichbinds to the IGF1 receptor expressed on the cell surface. Once bound,the IGF1 receptor initiates intracellular signaling. Fusion proteinswere first bound to apoptotic cardiac cells, which mimic the damagedstate of cells in vivo after myocardial infarction. The fusionprotein-bound cells were then used to stimulate IGF1 signaling inhealthy cardiac cells, mimicking the paracrine effect of the fusionproteins to activate signaling in nearby damaged or healthy cells at ornear the infarct zone. Phospho-Akt, a downstream target of IGF1signaling, was measured by ELISA. Cell-bound fusion protein was able tostimulate Akt signaling in heart cells. Wild type, non-fused IGF1 didnot induce Akt signaling indicating that the annexin V targeting domainof the fusion protein was critical for signaling to occur. Likewise, theAnxV_mHSA fusion protein did not stimulate Akt signaling, indicatingthat the targeting domain itself was not sufficient for signaling.Collectively, these data show that fusion proteins are bi-functional,being capable of specifically target damaged tissue and capable ofsignaling cellular pathways in a paracrine-like fashion via theiractivator domains. The results demonstrate a therapeutic role for fusionproteins to accumulate specifically in damaged tissue and not in healthytissue, to then modulate survival or regeneration through the activatordomains.

In a first step, the fusion protein was allowed to accumulate withdamaged cells through annexin V-phosphatidylserine binding in HL1cardiomyocytes undergoing apoptosis. Apoptotic cell death was induced byoxidative stress from treatment with hydrogen peroxide (H2O2). Bindingof the fusion protein to damaged cells was carried out by incubating thefusion protein with detached apoptotic cells contained in the growthmedium of H2O2 treated cells. In a second step, the bioactivity of theactivator domain of cell-bound fusion protein was assessed in vitro bystimulating serum-starved cardiomyocytes with the cell-bound fusionprotein. After washing to stop the stimulation, downstream signaling instimulated cells was measured by ELISA for phospho-Akt (pAkt). Thelevels of pAkt induced by the fusion protein were compared to that of acommercially obtained, non-fused version of its activator domain as wellas that of a fusion protein that contained the annexin V targetingdomain but lacked the activator domain.

The fusion protein IGF1_mHSA_AnxV (SEQ ID 136) was expressed andpurified as described in Example 5. HL-1 cells (William C. Claycomb,Louisiana State University Health Sciences Center), a cardiac musclecell line with characteristics of adult cardiomyocytes, were seeded ingelatin/fibronectin pre-coated 96-well plates (BD/Falcon, 353072) at 1:2in complete medium (Claycomb medium (Sigma, 51800C), containing 10% FBS(Sigma, 12103C), 2 mM L-glutamine (Invitrogen/Gibco, 25030), 100 U/mLpenicillin+100 μg/mL streptomycin (Invitrogen/Gibco, 15070), and 0.1 mMnorepinephrine (Sigma, A0937)) and incubated at 37° C. and 5% CO2. Thefollowing day, the cells were re-fed with 0.1 mL/well of mediumsupplemented with 400 uM H2O2 (Sigma, H1009), and incubated for 15 minat 37° C. and 5% CO2. Next, the H2O2-supplemented medium was aspiratedfrom each well and replaced with complete medium and the cells wereincubated for 20-24 hr at 37° C. and 5% CO2. The next day, medium fromthe wells was transferred into a 96-deepwell v-bottom plate (USAScientific, 1896-1110) to collect detached cells. For each sample,medium from 3 wells were pooled into 1 well of the 96-deepwell v-bottomplate. Collected cells were then incubated with fusion proteins in thepresence of calcium (binding buffer, a component of Annexin V-FITCapoptosis detection kit, BD Biosciences, 556547) for 15 minutes at 37°C. and 5% CO2. Fusion protein-bound cells were pelleted bycentrifugation and washed once with PBS (Sigma, D8537), after which,cells were resuspended in 100 μL/well DMEM containing calcium (bindingbuffer). HL-1 cells that were seeded in gelatin/fibronectin pre-coated96-well plates and serum starved in advance were then stimulated withthe 100 μL/well resuspended fusion protein-bound cells for 20 minutes.Stimulated cells were then washed and subjected to an ELISA protocol asdescribed in Example 5. Healthy HL-1 cells that were not exposed to H2O2were also harvested by trypsinization using 40 uL/well of 0.025%Trypsin-EDTA and placed in a 37° C. incubator. Cell detachment wasmonitored under a microscope and 100 μL/well of DMEM plus 10% FBS wasadded to deactivate the trypsin. For each sample, trypsinized cells from3 wells were pooled into 1 well of the 96-deepwell v-bottom plate. Cellswere washed with cold PBS, and resuspended in 300 μL of DMEM. Cells werethen incubated with fusion proteins in the presence of calcium,processed as described above, and used to stimulate HL-1 cells that wereseeded and serum starved in advance. Stimulated cells were washed andsubjected to an ELISA protocol as described in Example 8A.

An increase in phospho-Akt levels was observed only in cells stimulatedby apoptotically captured fusion protein containing both targeting(AnxV) and activator (IGF1) domains as shown in FIG. 27. Wild type,non-fused IGF1 was unable to stimulate cells, presumably because IGF1did not bind apoptotic cells and therefore was not captured. Both fusionprotein and wild type IGF1 have comparable activities as shown inExample 4C, thus the increase in phospho-Akt levels by captured fusionprotein was not caused by differences in their potencies. Althoughnon-fused IGF1 could in theory bind to the IGF1 receptor expressed onthe surface of apoptotic cells, there appeared to not be enough growthfactor retained to induce signaling, or the growth factor was retainedin a signaling-incapable way. Likewise, the AnxV_mHSA fusion protein wasunable to stimulate cells. While it was capable of binding apoptoticcells, as shown in Example 6, the AnxV_mHSA fusion protein was not ableto signal in a paracrine-like fashion since it lacked the activatordomain. Increases in phospho-Akt levels were not detected in cellsstimulated by any of the proteins that were premixed with untreatedcells, presumably because healthy cells do not have phosphatidylserineexposed on the cell surface for capture of the fusion proteins.Likewise, despite being able to bind IGF1 receptors on the cell surfaceof healthy cells, the capture of growth factor was not sufficient tostimulate cells. Taken together, the data demonstrate the simultaneoustargeting and activating functions of the fusion protein.

Example 10. In Vivo Targeting of Fusion Protein to Damaged Heart Tissue

We tested the hypothesis that the fusion protein IGF1_mHSA_AnxV (SEQ ID:136), which binds specifically through the AnxV targeting domain tophosphatidylserine on apoptotic and necrotic cells (Example 6), wouldaccumulate more and for longer in damaged heart tissue followingmyocardial infarction than IGF1_mHSA_AnxVm1234 (SEQ ID: 138) (a variantthat does not bind phosphatidylserine). An experimental myocardialinfarction (MI) was induced in mice, a test article was injectedintravenously (either IGF1_mHSA_AnxV, IGF1_mHSA_AnxVm1234, orvehicle-only control), animals were sacrificed 12, 24, or 72 hourslater, and protein accumulation in the infarcted, border zone, andremote (undamaged) areas of the heart was observed by ELISA andimmunohistochemistry. The immunohistochemistry demonstrated thatIGF1_mHSA_AnxV at 24 hours post-administration is localized in theborder zone at the edge of the infarct, while none of the nonbindingvariant is seen in the infarct, border zone, or remote (healthy) region.The ELISA data demonstrated that the targeted protein, IGF1_mHSA_AnxV,accumulates to a greater extent and for a longer time in the infarctedand border zones of the heart than the nonbinding variant proteinIGF1_mHSA_AnxVm1234. These data demonstrate the capability ofIGF1_mHSA_AnxV, a prototypical targeted fusion protein, to specificallyaccumulate and persist in damaged heart tissue following myocardialinfarction, enabling the specific delivery of fused activators domains.

Experimental myocardial infarction (MI) was induced in mice by ligationof the left coronary artery as explained below in detail. After 60minutes, the ligation was removed, allowing reperfusion of the heart.Dosing of test articles or vehicle control was done at 22 hours post-MIby injection in the tail vein. 15 mice per group were dosed with thefollowing:

Group 1: Vehicle-only control

Group 2: 15 μg IGF1_mHSA_AnxV Group 3: 15 μg IGF1_mHSA_AnxVm1234

For each group, 5 mice were sacrificed at each of the following times:12, 24, and 72 hours post-dosing. For each group/time point, 3 animalswere prepared for immunohistochemistry and 2 for ELISA, with the goal ofidentifying anti-HSA signal specific to IGF1_mHSA_AnxV orIGF1_mHSA_AnxVm1234 in or bordering the infarcted area of the heart.Detailed protocols follow.

The animal work was performed by Biotrofix, Inc., in laboratory spaceleased at ViviSource Inc., Waltham Mass. The protocol was reviewed andapproved by the ViviSource IACUC, and all animal welfare concerns wereaddressed and documented. Ninety (90) male C57/B6 12-week-old mice wereordered 7-10 days prior to study (including 15 for pilot studies,Charles River Laboratories). They were allowed free access to food andwater. Animals were assigned identification numbers using permanentmarker on the tail. The animals were observed the day prior to study,and those appearing to be in poor health were excluded. Animals werehoused in rooms provided with filtered air at 21±2° C. and 50%±20%relative humidity. The room was on an automatic timer for a light/darkcycle of 12 hours on and 12 hours off with no twilight. Shepherd's® ¼″premium corn cob was used for bedding and a Bio-Huts™ for Mice (BioSeryK3352) or a mouse Runnel™ (BioSery K3322, K3323) was put in each cage.Animals were fed with Lab Diet® 5001 chow. Water was provided adlibitum. The animals were housed 4 to 6 per cage.

On the day of surgery, the mouse was weighed, and anesthesia was inducedin a Plexiglas chamber with isoflurane in 100% 02. The mouse was placedon the surgery surface on a self-regulating heating pad. The mouse wassecured in place on its dorsum (ventral side up), endotracheallyintubated using an appropriate size intracath (22G), and maintained onisoflurane anesthesia at 1.0-2.5% in 100% 02. A surgical level ofanesthesia was confirmed by loss of palpebral reflex along with lack ofresponse to toe, heel, and tail pinch.

The thorax (from the lowest aspect of the dorsum to just across to theright side of the sternum) was shaved, fur was removed with vacuum, andthe skin was prepped with septisol. A skin incision was made over theleft thorax from the sternum to the mid-thorax region parallel with theribs. The intercostal muscles between ribs 5 and 6 were opened over theleft side of the heart and the ribs were retracted. The heart (leftventricle and left atrium) was identified, and the pericardium wasopened. The left lung was gently compressed inferiorly to remove it fromthe field. A 7-0 silk suture was placed around the left coronary arteryand ligated over a ˜2 mm piece of sterile polyethylene PE-10 tubing, andthe heart was observed for pallor (blanching, as evidence of ischemia)posterior to the ligation. The residual ends of the suture were cut, andthe ligation was removed by cutting through the PE tubing and silksuture after 60 minutes of ischemia time. The wound was kept moist bycovering the opening with a sterile warmed saline moistened gauzesponge. Once the suture was removed, the heart was observed for properreperfusion of the ischemic area. The left lung was re-inflated usingPEEP (positive end expiratory pressure), and the opposing ribs wereclosed with 6-0 non-absorbable monofilament nylon suture. The musclelayers were closed with 6-0 absorbable suture, followed by skin closurewith the 6-0 silk suture in continuous fashion.

Buprenorphine (Bedford Labs™ Lot: 18655303) was injected for analgesia(0.05 mg/kg, subcutaneously), the isoflurane was shut off, and the mousewas extubated once spontaneous respiration occured, and placed in aclean cage with supplemental heat for recovery. Following surgery,animals remained on a heating pad until they recovered from anesthesia.They were then returned to clean cages. They were observed frequently onthe day of surgery (Day 0) and at least once daily thereafter. Animalswere weighed before surgery on Day −1 and on Day 0 (day of surgery) andthen daily until sacrifice.

10 μL aliquots of test articles at the appropriate concentrations (IGF1Groups 1-3 defined above; vehicle, IGF1_mHSA_AnxV, orIGF1_mHSA_AnxVm1234 in endotoxin-free PBS) were stored at −80° C. untilthe day of use. Endotoxin-free PBS was stored at 4° C. Each test articlealiquot was thawed right before injection. 200 μL of endotoxin-free PBS(room temperature) was added to the test articles and mixed by pipettingup and down several times and then, using a no-headspace syringe, 200 μLwas injected into mice through the tail vein, at 22 (+/−1) hours afterthe MI.

At designated time points (12, 24, or 72 hours following dosing), themice were euthanized as follows: The animals were placed under deepketamine/xylazine anesthesia. For 3 animals per treatment group, thechest was opened and the heart was punctured at the apex. About 0.1 mlof 15% KCl was injected to the left ventricle, and the animal wasperfusion-fixed by normal saline followed by zinc formalin. The heartwas collected, stored in zinc formalin for 24-48 hours, then transferredto 70% Ethyl Alcohol, and stored at 4° C. The samples were then sent toMass Histology Services for immunohistochemistry measurements.

For 2 animals per treatment group, the animals were perfused with normalsaline. The heart was isolated and the left ventricle was washed withsaline. The heart was trimmed down to just the left and rightventricles, and dissected into four pieces as shown FIG. 28A. The pieceswere collected, weighed, flash frozen (in liquid Nitrogen), then storedin labeled microcentrifuge tubes (one sample per tube, hence 4 samplesper heart) at −80° C. and shipped to Silver Creek Pharmaceuticals on dryice.

To obtain heart tissue for immunohistochemistry and ELISA controlexperiments, several additional mice were euthanized as above withoutsurgery, the hearts were excised and rinsed as above, and in some, 2 μgof fusion protein IGF1_mHSA_AnxV in 15 μl was injected directly into theleft ventricle wall. Hearts with or without injected protein were fixedas described above in preparation for immunohistochemistry.

Immunohistochemistry Detection of Fusion Proteins

Immunohistochemistry was performed at Mass Histology Service Inc.,Worcester, Mass., a GLP-compliant histopathology laboratory. Theirstandard protocols for processing and staining fixed tissues fordetection of specific proteins were used. Briefly, the hearts fixed inzinc-formalin were dissected down to the ventricle and routinelyprocessed through a standard series of alcohols and xylene. Each heartwas embedded in paraffin, and sections were made on a Leica microtome atapproximately 6 microns in thickness each and placed on microscopeslides. For each heart, 8 serial transverse sections were made andplaced on slides, 100 μm was skipped, another 8 sections were made, 100μm was skipped, and this was repeated through the length of the heart.

Two slides from each set of 8 were stained, one with H&E to revealmorphology and the other stained with anti-HSA for HSA-localization,with DAPI counterstaining to show the nuclei of the cells. A traditionalprocess was used for H&E staining. Specifically, the tissue wasdeparaffinized in xylene, cleared in alcohol, hydrated in water, andstained in Harris hematoxylin. The slide was washed, stained in 1%aqueous eosin, dehydrated in a series of alcohols, cleared in a seriesof xylenes, and coverslipped. Slides representing sections at variouslevels of the heart were then viewed with the light microscope to locatesections containing infarcted regions.

For HSA-localization in the heart tissue, sections adjacent to thosestained for H&E were washed in xylene, cleared in alcohol, hydrated inwater, incubated overnight at 4C with goat anti-human albumin primaryantibody diluted 1:200, and rinsed in PBS. Alexa Fluor 594 donkeyanti-goat IgG, the fluorescently labeled antibody against goat anti-HSAantibody, was then used at a dilution of 1:400 for 1 hr at 37C as thesecondary antibody to detect the anti-HSA localization. The slides wererinsed in PBS, and coverslipped using ProLong Gold antifade reagentwhich also includes a DAPI stain for nuclear visualization.

For positive controls, slides from the hearts directly injected withIGF1_mHSA_AnxV were processed using the anti-HSA protocol as well. Inaddition, Mass Histology Services stained a sample of human livertissue, which contains native HSA, as a positive control for the primarydetection antibody. Negative controls included directly injected mouseheart that was processed for HSA-localization while leaving out theprimary anti-HSA antibody, and a naïve heart (no fusion proteinexposure) normally processed for HSA-localization.

ELISA Detection of Fusion Proteins

The four samples per heart (FIG. 28A) were prepared for ELISA asfollows. Samples were transferred to Eppendorf safe-lock microcentrifugetubes and were thawed on ice. To each tube, RIPA buffer including PierceHalt Protease Inhibitor Cocktail (diluted 100-fold into buffer) in a 1:5ratio of (mg tissue sample): (uL buffer) was added. At least 100 μLbuffer was used for each sample. A 50/50 mix of ZROB05 and ZROB10 beadsin a 1:2 ratio of beads:buffer were also added. Tubes were placed in aBullet Blender tissue homogenizer set to speed 9 and homogenized for 3minutes; this was repeated if homogenization was not complete. Thesamples were centrifuged and aliquots were taken to perform the BCA(bicinchoninic acid) protein assay to determine total protein in eachsample.

Enzyme-Linked Immunosorbent Assay (ELISA) measurements were done usingstandard methods. Specifically, on day 1, Reacti-Bind plates were coatedovernight, 4° C. with anti-HSA coating antibody diluted 1:50 inDulbecco's PBS. On day 2, wells were washed 4× with PBS-T (PBS, 0.05%Tween 20) using a plate washer (program 6). Nonspecific binding wasblocked with 200 uL/well protein-free blocking buffer for 2 hr at roomtemperature and wells were washed 4× with PBS-T (PBS, 0.05% Tween 20)using a plate washer. 50 uL/well (96 well plate) of either standardcurve sample or test samples were added to the wells. Test samples werediluted in RIPA buffer (+protease inhibitors) to a final total proteinconcentration of 8.745 mg/mL. Plates were sealed and incubated overnightat 4° C. On day 3, wells were washed 4× with PBS-T using a plate washerand 100 uL/well goat anti-HSA-HRP detection antibody diluted 1:25,000 inPBS-T was added per well and incubated 30 min at room temperature on ashaker platform at 220 rpm, protected from light. Wells were washed 4×with PBS-T using a plate washer. 1004 per well of 1-step Ultra TMB ELISAreagent at room temperature was added and plates were incubated at roomtemperature protected from light for 25 minutes. The reaction wasstopped with addition of 100 uL KLP TMB stop reagent. Color changes fromblue to yellow. After 5 minutes, absorbance readings were made on aplate reader at a wavelength of A450. Background values for absorbancefrom tissue with no fusion protein exposure were obtained from naïveheart samples produced using the same procedures as above. Thebackground value was subtracted from all test sample absorbance valuesto obtain the difference. A standard curve for theconcentration-absorbance relationship was generated from samples spikedwith a range of known amounts of fusion protein. Then the concentrationof protein in each test sample was determined by comparison to thestandard concentration-absorbance curve. Two aliquots from each hearttest sample were measured to assess measurement variability and theseare the basis of the standard deviations included in the ELISA data(FIG. 29).

Fusion proteins used include IGF1_mHSA_AnxV (targeted protein) andIGF1_mHSA_AnxVm1234 (nonbinding variant), produced as described inExample 5. Vehicle control was endotoxin-free PBS (Sigma). Animals weremale C57/B6 mice, 12-week-old when ordered, acclimatized 7-10 daysbefore surgery. Stains and antibodies used in immunohistochemistry:primary antibody was goat anti-human albumin (HSA) cross-adsorbedantibody, affinity purified (Bethyl Labs 080-229A lot #3); fluorescentlylabeled secondary antibody was Alexa Fluor 594 donkey anti-goat IgG(H+L) (Invitrogen, A11058); ProLong Gold antifade reagent with DAPI(Invitrogen, P36931). Reagents used for ELISA included RIPA Lysis andExtraction Buffer (Pierce, 89901); Pierce Halt Protease InhibitorCocktail, EDTA-free (Pierce, 78425); Pierce BCA assay kit, 23227;Reacti-Bind plates (Pierce, 15041); Dulbecco's PBS (Thermo, 28374);protein-free blocking buffer (Pierce, 37572); anti-HSA coating antibody(Bethyl labs antibody A80-229A); goat anti-HSA-HRP detection antibody(Bethyl Labs, A80-229P); 1-step Ultra TMB ELISA reagent (Thermo(Pierce), 34028); KLP TMB stop reagent (KLP, 50-85-05); protein-freeblocking buffer (Pierce, 37572); tissue homogenization beads (NextAdvance, ZROB05 and ZROB10). Materials used in animal surgery includedBuprenorphine (Bedford Labs™ Lot: 18655303), isoflurane, ketamine,xylazine, zinc formalin, and 15% KCl.

Detection of targeted and nonbinding variant fusion proteins by ELISAare summarized in FIG. 29. Protein measured in the infarct+border zonewas compared to protein in the non-infarcted region of the heart in twomice for each of the targeted (Group 2) and nonbinding variant (Group 3)fusion proteins at three times after dosing (12, 24, and 72 hours). Foreach heart, the protein measured in samples A and B1-remote (as definedin FIG. 28A) were added, and represent the protein in the non-infarctedregions of the heart. Likewise, the protein measured in samplesB1-infarct and B2 were added, and represent the protein in the infarctedregion plus surrounding border region of the heart.

As shown in FIG. 29, IGF1_mHSA_AnxV, the targeted fusion protein (Group2, black bars), was highly elevated in the infarct region at both 12-and 24-hours post-injection, compared to its level in the remote regionsof heart (Group 2, gray bars) in the same animals. It is undetectable inboth infarcted and noninfarcted regions by 72 hours. In comparison,nonbinding variant protein IGF1_mHSA_AnxVm1234 (Group 3, black bars)were somewhat elevated at 12 hours, decreasing by 24 hours andundetectable at 72 hours. Comparing the targeted to nonbinding protein,at both 12 and 24 hours, the targeted IGF1_mHSA_AnxV was more elevatedin the infarct+border zone (black bars, Group 2) than is nonbindingIGF1_mHSA_AnxVm1234 (black bars, Group 3). These results demonstratethat the fusion protein IGF1_mHSA_AnxV, which is targeted to the damagedcardiomyocytes (by actively binding phosphatidylserine associated withapoptotic or necrotic cardiomyocytes), can enter and be retained in theareas of the heart damaged by the experimental MI at higherconcentrations and for longer times than the nonbinding variant. Inaddition, the data showed specific localization of the targeted fusionprotein to the damaged areas of the heart, demonstrating efficacy oftargeting via the AnxV targeting domain.

Localization of HSA-containing fusion proteins by immunohistochemistryalso demonstrated greater accumulation of IGF1_mHSA_AnxV in the infarctand bordering region compared to the nonbinding variantIGF1_mHSA_AnxVm1234 at 24 hours after dosing. FIGS. 30A-30C showsmorphology of the infarct and surrounding tissue, as well as positivestaining specific for IGF1_mHSA_AnxV at the infarct edge and borderregion around the infarct. Top left (FIG. 30A): H&E stain showingmorphology. The infarcted region is central, with the edge demarcated bythe black curve, and viable is in the upper left and lower right. (200×magnification) Top right (FIG. 30B): A serial section of this regionstained for HSA-containing proteins at the same magnification. Redindicates HSA localization; blue indicates DAPI staining of cell nuclei.Higher magnification images of the same region are shown in the lowerleft (400×, FIG. 30C) and lower right (600×, FIG. 30D). There ispositive signal in cardiomyocytes (thin arrows) at the edge of infarctedtissue (medium thickness arrows). White boxes in Top left and right arein approximately in the same place in two adjacent 6 um slides, and theLower left and right images are magnifications near the area of thoseboxes.

By comparison, FIGS. 31A-31D shows the same information for thenonbinding mutant IGF1_mHSA_AnxVm1234 showing minimal staining specificfor it. Top left (FIG. 31A): H&E stain showing morphology. The infarctedregion is in the upper central part of the image, with the edgedemarcated by the black curve (200× magnification). Top right (FIG.31B): An adjacent section of this region stained for HSA-containingproteins at the same magnification. Red indicates anti-HSA localization;blue indicates DAPI staining of cell nuclei. Higher magnification imagesof the same region are shown in the lower left (400×, FIG. 31C) andlower right (600×, FIG. 31D). There is only background signal incardiomyocytes (thin arrow) and red blood cells (thick arrow) at theedge of infarcted tissue (medium thickness arrows). White boxes in Topleft and right are in approximately in the same place in two adjacent 6um slides, and the Lower left and right images are magnifications nearthe area of those boxes.

FIG. 32A-32D illustrates the controls used to confirm specificity of theanti-HSA antibody for the HSA-containing fusion proteins. Top left (FIG.32A): Positive control in a mouse heart in which IF1 mHSA_AnxV had beendirectly injected as described. Dark red indicates strong localizationof HSA-containing fusion protein where it was injected. Top right (FIG.32B): Negative control in mouse heart. Same preparation as in Top leftincluding injection of IGF1_mHSA_AnxV but staining proceeded without theprimary anti-HSA antibody. No specific staining seen. Bottom left (FIG.32C): Second negative control in mouse heart. No protein was injected inthe heart, and it was processed as in the top left. Only faint redbackground staining can be seen. Bottom right (FIG. 32D): Positivecontrol in human liver. Human liver produces significant amounts of HSA.Staining with the anti-HSA antibody shows specific staining throughoutthe sample. In all images: Blue staining is DAPI stain indicating cellnuclei.

It is understood that the examples and embodiments described herein arefor illustrative purposes only and that various modifications of changesin light thereof are to be included within the spirit and purview ofthis application and scope of the appended claims. All publication,patents and patent applications cited herein are hereby incorporated byreference in their entirety for all purposes.

1.-20. (canceled)
 21. A bi-specific fusion protein comprising: (a)Annexin V comprising an amino acid sequence having at least 99% identitywith SEQ ID NO: 31, and (b) IGF-1 comprising an amino acid sequencehaving at least 98.5% identity with SEQ ID NO:
 3. 22. The bi-specificfusion protein of claim 21, further comprising a half-life modulator.23. The bi-specific fusion protein of claim 22, wherein the half-lifemodulator is a non-immunogenic protein.
 24. The bi-specific fusionprotein of claim 22, wherein the half-life modulator comprises asequence from one of human serum albumin, alpha-fetoprotein, vitaminD-binding protein, transthyretin, single-chain of antibody Fc domain,proline-, alanine-, and/or serine-rich sequences, albumin-binding domainantibody, variants thereof, fragments thereof and combinations thereof.25. The bi-specific fusion protein of claim 22, wherein the half-lifemodulator comprises at least 100 consecutive amino acids that are atleast 80% identical to a serum albumin amino acid sequence.
 26. Thebi-specific fusion protein of claim 21, wherein the IGF-1 is at theamino terminus and the Annexin V is at the carboxy terminus of thebi-specific fusion protein.
 27. The bi-specific fusion protein of claim21, wherein the Annexin V is at the amino terminus and the IGF-1 is atthe carboxy terminus of the bi-specific fusion protein.
 28. A method fortreating kidney tissue damage, the method comprising: administering to asubject in need thereof a therapeutically effective amount of abi-specific fusion protein comprising Annexin V comprising an amino acidsequence having at least 99% identity with SEQ ID NO: 31, and IGF-1comprising an amino acid sequence having at least 98.5% identity withSEQ ID NO:
 3. 29. The method of claim 28, wherein the bi-specific fusionprotein further comprises a half-life modulator.
 30. The method of claim29, wherein the half-life modulator is a non-immunogenic protein. 31.The method of claim 29, wherein the half-life modulator comprises asequence from one of human serum albumin, alpha-fetoprotein, vitaminD-binding protein, transthyretin, single-chain of antibody Fc domain,proline-, alanine-, and/or serine-rich sequences, albumin-binding domainantibody, variants thereof, fragments thereof and combinations thereof.32. The method of claim 29, wherein the half-life modulator comprises atleast 100 consecutive amino acids that are at least 80% identical to aserum albumin amino acid sequence.
 33. The method of claim 28, whereinthe IGF-1 is at the amino terminus and the Annexin V is at the carboxyterminus of the bi-specific fusion protein.
 34. The method of claim 28,wherein the Annexin V is at the amino terminus and the IGF-1 is at thecarboxy terminus of the bi-specific fusion protein.